City of London - Special Event Request Form

Section 1 - Organization Information

Name of Organization (should be the same as listed on your insurance policy)

Main Contact (signing officer for the organization)

Main Contact (organizing event)

Organization Mailing Address (including city and postal code)

Primary Phone #

Secondary Phone #

E-mail address

Preferred method of communication

E-mail
Phone

Section 2 - Event Information

Name of Event

Start Date of Event

End Date of Event

How many attendees are expected in total for this event?

Description of Event

Section 3 - Event Location

Please indicate the location you are requesting for your event. If requesting a Street Closure or Showmobile, please skip this question.

If you selected 'Other Park', please indicate your preferred location:

Street Closure?

Yes
No

Name of Street(s) to be closed (eg. Talbot St.):

Between which two cross streets are you requesting the closure? (eg. Dundas St. to York St.)

Showmobile Requested?

Yes
No

Section 4 - Event Dates

**SETUP**

Setup Day 1

Start Time:

End Time:

Setup Day 2 (if required)

Start Time:

End Time:

**EVENT DAYS**

Day 1

Event Start Time:

Event End Time:

Day 2

Day Two - Event Start Time:

Day Two - Event End Time:

Day 3

Day Three - Event Start Time:

Day Three - Event End Time:

Day 4

Day Four - Event Start Time:

Day Four - Event End Time:

Day 5

Day Five - Event Start Time:

Day Five - Event End Time:

**CLEAN UP**

Day 1

Cleanup Start Time:

Cleanup End Time:

Day 2

Day Two: Cleanup Start Time (if required):

Day Two: Cleanup End Time:

Section 5 - Mandatory Event Details

Is your organization incorporated?

Yes
No

If yes, please provide incorporation number:

Beer Garden?

Yes
No

If yes, please provide security company details:

Inflatables/Bouncy Castles?

Yes
No

If yes, please provide supplier details:

Skating Tents/Other?

Yes
No

If yes, please provide date(s):

Thank you - please remember to click the SUBMIT button. A member of the Special Events Team will be in contact within 5-10 business days. Any general inquiries about this application should be emailed to specialevents@london.ca.