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Sponsoring Organization:______________________________

Is this a non-profit organization? -Yes -No

Sponsor Address (Return Address):______________________________

Contact Person:______________________________

Contact Person Address (Return Address):______________________________

Phone # (Home):____________________     Phone # (Cell):_____________________     Phone # (Work):____________________


Name of Event:______________________________

Type of Event Activity:______________________________

Date(s) of Event:______________________________     Time of Event (start and finish):______________________________

Is there a fee charged to participants? -Yes -No -If Yes, fee amount: $

Is there a fee charged to spectators? -Yes -No -If Yes, fee amount: $

Number of Participants:____________________

Number of Participating Boats (if applicable):____________________

Number of Monitoring/Safety Boats (if applicable):____________________

Number of Spectators (if applicable):____________________

Number of Spectators Boats (if applicable):____________________

Corps Project / Proposed Location of Event:______________________________

Location of Water to be Used (nearest river mile):______________________________

With full knowledge and understanding of the risks involved, I agree to hold the U.S. Army Corps of Engineers, the Federal Government, and agency of the Federal Government, officers, agents, servants, employees and contractors of the U.S. Army Corps of Engineers/Federal Government harmless for any damage to property or injury to persons resulting from the event.


Signature of Sponsor's Representative:_________________________________

* Before submitting read & print a copy of the Special Event Guidelines and Conditions

                                                                                    ***DO NOT COMPLETE BELOW THIS LINE***


Date Received:____________________

Payment Amount Included:______________

____Approved ____Denied ____Incomplete Information

Reviewing Officials Signature:____________________________________

Special Events Permit Number(s):____________________     Special Events Permission Number(s):____________________