Request For Use Of The Public Domain For Road Or A Land Belonging To The Town Step 1 of 3 33% Name of the organization (optional)Contact person* Name Phone number*Email* Name of the person responsible on the site, if different (optional) Name Phone on the day of the event, if different (optional)Event InformationName of the event*Event Date Date Format: MM slash DD slash YYYY Time of the event (start) : HH MM AM PM Time of the event (end) : HH MM AM PM Other Dates? Yes Please add all the event dates below.Event DateTime of the Event (start)Time of the Event (end) Location(s) of the event* Lions Park Coldbrook Park Others (specify): Adresse* Street Address Address Line 2 Road closure* yes no If your event requires a road closure belonging to the MTQ, you must complete the form available at this address (French only): bit.ly/2OgACF6 Attendance :* Reunion Permit mandatory- A form must be used to apply for a liquor permit for a family, social, cultural, educational or sporting event if the organizer wishes to serve or sell alcoholic beverages (bit.ly/2TJVavL) The event involves : Alcohol Food Tents BBQ Portable toilets Signalisation Signs Stages or amplifiers Food truck/ vendors Live animals Fireworks Please indicate your requests for us of town equipment : Provide a copy of the following documents : If a document is missing from your file, a representative of the Town will contact you at the address mentioned above. Please note that other documents may be requested following the preliminary study of your request (eg approval from the MTQ for the holding for a road closure).Description of the eventProof of insuranceRésolution from the organizationPublicity with schedule of the eventEvent Cancelation PolicyLiquor licence (if necessary)Plan of the site(location of first aid kits, rescue equipment, treatment centres, location of volunteers, tents, tables, toilets, etc…)Emergency plan Information Martin Lussier Coordinator of Recreation, Culture and Community Life martin.lussier@ville.lac-brome.qc.ca / T 450 243-2020, extension 311Email me a copy of this form Yes CommentsThis field is for validation purposes and should be left unchanged.