Form Center

2. Event Name/Purpose*
4. APPLICATIONS MUST BE RECEIVED NO LESS THAN 60 DAYS PRIOR TO YOUR REQUESTED DATE.

   The reservation is for a maximum 5-hour time block and will include Parks and Public Works staff to assist with your event.

6. 1st Choice Event Date*
   1st Choice Event Date
7. 2nd Choice Event Date*
   2nd Choice Event Date
9. Event Start and End Time
   Event Start and End Time Start Time

   —

   Event Start and End Time End Time
11. Hours Being Requested Including Setup and Breakdown
    Hours Being Requested Including Setup and Breakdown Start Time

    —

    Hours Being Requested Including Setup and Breakdown End Time
13. Estimated Number of Attendees*
14. Estimated Number of Vendors
16. Is this an annual event?

    1. Yes

    1. No
17. If so, how many years and in what location(s)?
19. Organization Name:*
21. Are you a non-profit?

    1. Yes

    1. No
22. If so, please provide the organization's EIN.
24. Contact Person/Organizer*
26. Phone Number*
27. Email Address*
29. Mailing Address
31. Street Address Line 1
33. Street Address Line 2
35. City
36. State
37. Zip Code
39. Race Organizer Contact Person*
41. Phone Number*
42. Email Address*
44. Mailing Address
46. Street Address Line 1
48. Street Address Line 2
50. City
51. State
52. Zip Code
54. In addition, would you like to reserve the pavilion?

    1. Yes

    1. No
55. Note:

    You will be charged the resident rate per the current fee schedule.

57. The reservation includes three (3) 6-foot tables and two (2) trash barrels. Do you need to request additional equipment?

    1. Yes

    1. No
59. If yes, please explain.
61. Do you have any additional requests or alterations to the 5K Package?

    1. Yes

    1. No
63. If yes, please explain.
65. Download, Read, and Sign the 5K Run/Walk Agreement
    5K Run/Walk Agreement
67. Upload the Signed 5K Walk/Run Agreement
69. Acknowledgement*

    1. Yes
    2. No

    I understand that submission of this form does not guarantee approval or reservation. The City of Lilburn will not confirm any event reservations until the official City Event Calendar has been established. Every effort is made to finalize the City Event Calendar by the end of the calendar year.

71. Agreement

    I agree to protect, indemnify, and defend the City, its authorized agents, elected and appointed officials and all employees against any and all claims as a result of persons attending this event. This provision includes any expenses incurred by the City defending such claim.

    I have read the terms and conditions outlined in the 5K Walk/Run Agreement (linked above). I further agree to abide by the Agreement as well as the ordinances of the City of Lilburn and I accept responsibility for any violations as they may pertain to the application.

    1. I agree with the above statements
73. Signature

    (Type your name to provide digital signature)

74. Date
    Date
Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit

* indicates a required field