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2. City of Blytheville Event Application

   To allow ample time for the city and applicant to prepare and secure proper permits, this form must be submitted a minimum of 30 business days, not including Holidays, prior to the requested event date except for Marches / Demonstrations which only require a 24-hour notice. Pease keep in mind that multiple city departments or community organizations may have specific requirements to approve an event and there may be fees, costs or deposits required. Submission of this form does not guarantee an event will be approved. To avoid any delays, please be as detailed as possible. 

4. Please choose one*

   1. I agree with the above statement

   1. I disagree with the above statement
6. Using the definitions below, which category best describes your event.*

   1. Parade
   2. Festival
   3. Run / Walk
   4. Auto Show / Rally / Expo

   1. Non-Profit Fund Raiser
   2. For Profit Venture
   3. March / Demonstration
   4. Entertainment / Concert

   1. Block Party
   2. Fair / Carnival
   3. Arts / Crafts Fair
   4. Holiday Ceremony
8. Abbreviated Definitions

   PARADE: Marches, Processions, Pageants, Ceremonies or Exhibition of persons, animals, vehicles, conducted on any city street, public right-of-way or other property owned by the city, which interferes with normal use, / does not comply with normal traffic laws. 

   FESTIVAL: A periodic celebration or program of events or entertainment usually having a specified focus or theme conducted in any city park, street, public right-of-way, or other property owned by the city, interferes with the usual normal public use.

   RUN/WALK: A group of persons collectively engage in a sport or form of physical exercise conducted upon any city street, or other property owned or controlled by the city, which interferes with the usual, normal public use / does not comply with normal traffic laws. 

   AUTO SHOW/EXPO A public display or demonstration of items, skills or works of interest, conducted upon any city park, street, or public right-of-way which interferes with the usual normal public use.

   NON-PROFIT FUND RAISER: The raising of funds for a nonprofit organization by solicitation of funds or sale of items conducted upon any, city park, street, public right-of-way, which interferes with the usual normal public use. 

   FOR PROFIT VENTURE: Any event, activity or enterprise entered into for profit for the benefit, advantage, or pecuniary gain of an individual, business or organization upon any, city park, street, public right-of-way, which interferes with the usual normal public use.

   MARCH/DEMONSTRATION: Any meeting or gathering of a group exercising their constitutional rights conducted upon any city park, street, or public right-of-way, which interferes with the usual normal public use.

   ENTERTAINMENT/CONCERT: A live, staged musical, comedy, dramatic performances, which tickets are sold by a promoter, conducted upon any, city park, street, public right-of-way, which interferes with the usual normal public use. 

   BLOCK PARTY: A festive gathering for all residents on a block of street in a residential neighborhood, typically requiring a closure of a street, or portion thereof to the general public and use of the street for the activities which interferes with the usual normal public use.

    FAIR/CARNIVAL: A traveling business providing commercial entertainment consisting of sideshows, concessions, rides, games of chance, and other amusements, conducted upon any, city park, street, public right-of-way, which interferes with the usual normal public use.

   ARTS/CRAFTS FAIR: A gathering for display, trade or sale, articles of artistic or handmade workmanship, conducted upon any city park, street, public right-of-way, which interferes with the usual normal public use.

10. Event Name / Title*
11. Event Location*
13. Event Date and Time Frame*
    Event Date and Time Frame Start Date

    Event Date and Time Frame Start Time

    —

    Event Date and Time Frame End Date

    Event Date and Time Frame End Time
14. Which best describes the Event Location*

    1. Private Residence or Lot
    2. Private Business or Building
    3. Private Parking Lot

    1. Public Park or Lot
    2. Public Street
    3. Public Parking Lot
16. Is this a Public or Private Event?*
    -- Select One --PublicPrivate
17. Is there a fee to Participate as a Vendor?*
    -- Select One --YesNoN/A
18. Is there a Cover Charge or Entrance Fee to Attend*
    -- Select One --YesNo
19. Has the Event ever been Held in Blytheville before?*
    -- Select One --YesNo
21. If Yes Date of Previous Event
    If Yes Date of Previous Event
22. Estimated Number of Participants (Not including for profit Mobile Food Vendors)*
    -- Select One --Less than 1010-2525-5050-100100 or More
23. Estimated Number of Attendees*
    -- Select One --Less than 2525-5050-100100-500500 or More
25. Which best describes the Event*

    1. City Promoted
    2. Civic Group / Club Promoted

    1. Non-Profit Group Promoted
    2. For Profit Self-Promoted

    1. For Profit Business Promoted
29. APPLICANT INFORMATION

    The following pertains to the person submitting the application on behalf of themselves or their organization

31. Name*
32. Email Address*
34. Physical Address*
35. City*
37. State*
38. Zip Code*
39. Social Media Account / Website
41. Home or Business Phone Number*
42. Cell Phone Number
43. Fax Number
47. SPONSOR / HOST / PROMOTER INFORMATION

    The following pertains to the organization, business or individual sponsoring / hosting / promoting the event. Sponsors / Hosts / Promoters must provide an on-site event manager who is responsible for all aspects of the event. 

49. Please choose one*

    1. I agree with the above statement

    1. I disagree with the above statement
51. Sponsor / Host / Promoter Name*
52. Sponsor / Host / Promoter Email Address*
54. Sponsor / Host / Promoter Address*
55. Sponsor / Host / Promoter City*
57. State*
58. Zip Code*
59. Sponsor / Host / Promoter Social Media / Website*
61. Sponsor / Host / Promoter Phone #*
62. Sponsor / Host / Promoter Cell #
63. Sponsor / Host / Promoter Fax #
65. Sponsor / Host / Promoter On-Site Event Manager Name*
66. Sponsor / Host / Promoter On-Site Event Manager Cell #*
68. Organization Status *

    1. Non-Profit / Not for Profit
    2. For Profit
69. For Profit Tax ID
70. Business License # and City Issued
74. ALCOHOL

    It is unlawful for any person to sell, barter, exchange, or give alcoholic liquor without having a valid license. It is unlawful to consume alcohol in the public view in a place not licensed to consume alcohol. No alcohol will be allowed without a proper State ABC Permit. Applicants for events with alcohol must provide at their cost onsite Certified Law Enforcement or State Licensed Security. 

76. Please Choose One*

    1. I agree with the above statement

    1. I disagree with the above statement
78. Will alcohol be sold / consumed at this event?*

    1. Yes
    2. No
79. If Yes, ABC Permit #
80. Or, have you applied for an ABC Temporary Permit

    1. Yes
    2. No
81. If Yes, Upload a copy of your ABC Permit Application here
85. FOOD VENDORS

    Event Organizers are responsible for ensuring all for profit food vendors have current business and State Health Department license. Event Organizers must ensure all Non-Profit Food Vendors or providers comply with all Arkansas Department of Health "Guidelines for Operating a Temporary Food Service " https://www.healthy.arkansas.gov/images/uploads/pdf/temporaryfoodserviceguidelines.pdf 

87. Please Choose One*

    1. I agree with the above statement

    1. I disagree with the above statement
89. Mobile Food Vendors

    When an Event Permit is issued a Permit # is assigned, As you promote your event, Mobile Food Vendors may register with the city within 3 business days of your event by going to the Mobile Food Vendor section on the City of Blytheville website, filling in the form and providing your assigned Event Permit #. This will help ensure they are in compliance with all State and Local Licensing requirements.

91. Will Food be Prepared, Sold or Given Away? *
    -- Select One --YesNo
92. If so, Anticipated Number of For Profit Mobile Food Vendors
    -- Select One --Less than 55-10More than 10N/A
93. If so ,Anticipated Number of Non-Profit Food Giveaways
    -- Select One --Less than 55 - 10More than 10N/A
97. VEHICLE AND PEDESTRIAN TRAFFIC

    Requests to close Public City Streets to the normal flow of vehicle and pedestrian traffic for private use alone are prohibited. Requests to Close streets in residential areas requires the event host / sponsor to notify / obtain signatures from all residents affected by the street closure 30 days prior to the planned event. Requests to Close Public City Streets in Business Districts requires the event host / sponsor to notify all businesses affected by the street closure 30 days prior to the planned event. Requests to close or in any way interfere with the normal traffic flow of any State or US Highway requires State Approval. The event host / sponsor is responsible for obtaining those permits from the State and must provide them to the city prior to the event. Marches / Demonstrations only require a 24-hour notice but can be prohibited in residential areas.

99. Please Choose One*

    1. I agree with the above statement

    1. I disagree with the above statement
101. Event Parking Location(s)*
103. Which best describes the Parking Location*
     -- Select One --Public Parking Lot / Public StreetPrivate Parking Lot / Private Drive
104. If Private, has the owner agreed
     -- Select One --YesNoNo Private Parking Required
105. Parking Attendant Provided?*
     -- Select One --YesNo
106. Will the Event Require closing a public street?*
     -- Select One --YesNo
108. What Street(s) are requested to be closed (If none type none)*
110. From Intersection or Block Number (if none type none)*
111. To Intersection of Block Number (if none type none)*
113. Date and Time Street(s) to be Closed
     Date and Time Street(s) to be Closed

     Date and Time Street(s) to be Closed
114. Date and Time Street(s) to be Re-Opened
     Date and Time Street(s) to be Re-Opened

     Date and Time Street(s) to be Re-Opened
118. SANITATION

     All event hosts / promoters / sponsors are responsible for cleaning the public streets and sidewalks of trash / debris generated by the event. Hosts / Promoters / Sponsors are required, at their expense, to provide trash receptacles, trash collection, porta-potties and wash stations as may be needed for the event. Arrangements for trash collection can made with the City of Blytheville Public Works Department not less than ten (10) business days prior to the event. Private Businesses are not required to allow the public to use their restrooms for your event. Please remember this and the number of anticipated attendees, Participants, food vendors and activities when planning on the number of portable toilets and trash receptacles.

120. Please Choose One*

     1. I agree with the above statement

     1. I disagree with the above statement
122. Will Portable Toilet Facilities Be Required*
     -- Select One --YesNo
123. If so how many and where
125. Will Additional Trash Receptacles Be Required*
     -- Select One --YesNo
126. If so how many and where
130. SECURITY SAFETY AND EMERGENCY SERVICES

     Safety and Security is an important aspect at each event. Hosts / Promoters / Sponsor are responsible for providing such security as may be deemed necessary by the City for the planned event and activities. Hosts / Promoters / Sponsor must provide their plans for security in this application. Remember if Alcohol will be sold or consumed at the event you must provide State Certified Security or Law Enforcement Officers. If you need help in developing a plan you may contact  Blytheville Police and Fire Departments.

132. Please Choose One*

     1. I agree with the above statement

     1. I disagree with the above statement
134. Will EMS be stationed at the event?*
     -- Select One --YesNo
135. If so EMS Providers Name
136. Will Licensed Security or Police be at the event*
     -- Select One --YesNo
137. If so Name / State License #
139. In Case of Street Closures, Access Point for Emergency Services to Enter the Event
143. LIABILITY INSURANCE / FEES / DEPOSITS

     The city does not provide liability insurance for the event. If insurance is required for the event   sponsor / hosts / promoters will be responsible for such insurance. The final decision for the need of liability insurance shall be determined by the City Attorney. If liability insurance is required, it shall be in the minimal amount set by City Ordinance.

145. Please choose one*

     1. I agree with the above statement

     1. I disagree with the above statement
147. Do you have Liability Insurance for the Event*
     -- Select One --YesNo
148. If Yes, Insurance Co and Policy #
150. OTHER CONSIDERATIONS

     Utilities may not be available in all event requested areas. Please be mindful of noise and time-of-day sensitive areas such as but not limited to residential neighborhoods, nursing homes, schools and hospital. The City of Blytheville wants you to have an enjoyable successful event. Please review the following things you may need when planning your event. 

152. Please Choose One*

     1. I agree with the above statement

     1. I disagree with the above statement
154. Check as many as needed*

     1. Electric Generators Required
     2. Portable Lighting Required

     1. Fireworks Permit Required
     2. Elevated Noise Levels Required
Leave This Blank:


156. 1. Receive an email copy of this form.
157. Email address

     This field is not part of the form submission.

158. Submit

* indicates a required field