City of Blytheville Event Application

City Collector

Required fields

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Abbreviated Definitions

Event Name / Title

Event Location

Event Date and Time Frame

Which best describes the Event Location

Private Residence or Lot Private Business or Building Private Parking Lot Public Park or Lot Public Street Public Parking Lot

Is this a Public or Private Event?

Is there a fee to Participate as a Vendor?

Is there a Cover Charge or Entrance Fee to Attend

Has the Event ever been Held in Blytheville before?

If Yes Date of Previous Event

Estimated Number of Participants (Not including for profit Mobile Food Vendors)

Estimated Number of Attendees

Which best describes the Event

City Promoted Civic Group / Club Promoted Non-Profit Group Promoted For Profit Self-Promoted For Profit Business Promoted

APPLICANT INFORMATION

Name

Email Address

Physical Address

City

State

Zip Code

Social Media Account / Website

Home or Business Phone Number

Cell Phone Number

Fax Number

SPONSOR / HOST / PROMOTER INFORMATION

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Sponsor / Host / Promoter Name

Sponsor / Host / Promoter Email Address

Sponsor / Host / Promoter Address

Sponsor / Host / Promoter City

State

Zip Code

Sponsor / Host / Promoter Social Media / Website

Sponsor / Host / Promoter Phone #

Sponsor / Host / Promoter Cell #

Sponsor / Host / Promoter Fax #

Sponsor / Host / Promoter On-Site Event Manager Name

Sponsor / Host / Promoter On-Site Event Manager Cell #

Organization Status

Non-Profit / Not for Profit For Profit

For Profit Tax ID

Business License # and City Issued

ALCOHOL

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Will alcohol be sold / consumed at this event?

Yes No

If Yes, ABC Permit #

Or, have you applied for an ABC Temporary Permit

Yes No

If Yes, Upload a copy of your ABC Permit Application here

PDF, Word, JPG, or PNG up to 10 MB

FOOD VENDORS

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Mobile Food Vendors

Will Food be Prepared, Sold or Given Away?

If so, Anticipated Number of For Profit Mobile Food Vendors

If so ,Anticipated Number of Non-Profit Food Giveaways

VEHICLE AND PEDESTRIAN TRAFFIC

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Event Parking Location(s)

Which best describes the Parking Location

If Private, has the owner agreed

Parking Attendant Provided?

Will the Event Require closing a public street?

What Street(s) are requested to be closed (If none type none)

From Intersection or Block Number (if none type none)

To Intersection of Block Number (if none type none)

Date and Time Street(s) to be Closed

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

SANITATION

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Will Portable Toilet Facilities Be Required

If so how many and where

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Email address

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