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4. First Name
5. Last Name
7. Phone Number
9. Email Address
11. Address
13. City
14. State
15. Zip Code
17. Name of Event
19. Description of Event
21. Purpose of Event
23. Please list stakeholders and their role in Event:
25. Proposed Event Date(s):
26. Frequency of Event
27. Proposed Start Time
28. Proposed End Time:
30. Proposed Fee Per Person

    (Leave blank if you don’t have a specific location in mind.)

32. Is this event intended for a specific demographic?

    (For example: age group, school level, gender, ethnicity, etc.)

34. Minimum Age for Event
35. Maximum Age for Event
37. Please list the supplies/entertainment you will provide:
39. Please list the supplies/entertainment you are requesting from Ephraim City:
41. Please list special site or set-up requirements needed for the event:
43. Any other details you would like to add:

45. If you have any questions or concerns about this application, please contact Hannah at hannah.larson@ephraimcity.org.

Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field