Public Property Request

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 Information
Name of the event*
Event Date
Date Format: MM slash DD slash YYYY
Time of the event (start)

: HH

MM
Time of the event (end)

: HH

MM
Other Dates?
- Yes
Please add all the event dates below.
Event Date Time 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

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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 event
Proof of insurance
Résolution from the organization
Publicity with schedule of the event
Event Cancelation Policy
Liquor 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 311
Email me a copy of this form
- Yes
Comments
This field is for validation purposes and should be left unchanged.

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Event Date	Time of the Event (start)	Time of the Event (end)

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