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Archdiocese of Baltimore
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Third Party Special Events Waiver Request Form
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Todays Date: 2/20/2019
Third Party Special Events Waiver Application Request Form
Location Information
Location Number (4 Digits):
*
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Location Name:
*
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Location Address:
*
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Location City:
*
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State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
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Location Contact:
*
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Email Address:
*
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Your Phone Number:
*
Fax Number:
Lessee Information
Lessee Contact:
*
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Address:
*
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City:
*
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State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
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Lessee Phone Number:
*
Lessee E-mail:
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Please specify the type of special event
(E.g. Wedding Reception, Anniversary party, etc.)
:
*
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Date of Event:
*
February, 2019
Sun
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27
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31
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06
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1
2
10
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9
Today
Clear
Jan
Feb
Mar
Apr
May
Jun
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Sep
Oct
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Dec
OK
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Time of Event:
*
to
Approximate Number of Participants:
*
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Is Liquor Being Served:
*
Yes
No
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Is Food Being Serverd:
*
Yes
No
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Is There Security:
*
Yes
No
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Special Instructions / Comments:
Any additional notes you would like to add.
THE COST FOR THIS WAIVER IS $100.00 FOR EVENTS TO BE HELD BETWEEN JULY 1, 2018 AND JUNE 30, 2019.
Checks are to be made payable to ARCHDIOCESE OF BALTIMORE.
By submitting this request, the lessee has requested that the insurance requirement within the thrid party facility use agreement be waived. Neither the Archdiocese nor the respective location is in the business of selling insurance. This transaction represents a waiver of a contract condition and fulfills the lesse's obligation to providing proof of insurance.
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