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18030 Foundation Drive, Suite A Noblesville, IN 46060 Phone: (317) 776-8500 Fax: (317) 776-8506 June 2025 Charles Harris, MD-Health Officer Event Organizer Registration Application This application must be submitted at least 30 days prior to the event Event Name: Event Address: Date(s) of Event: Event Hours: Person(s) in Charge of Event (PIC): PIC Phone Number: E-Mail: Organization Name: Organization Address: City: Food Service start and end times: Expected Daily Number of Food Establishments/Vendors at the Event: Will food vendors have varying service times? ☐ YES ☐ NO *If yes, note on vendor list* Will this event be reoccurring? ☐ YES ☐ NO I If yes, how often? ☐ Weekly ☐ ☐ Annually Organizers should provide basic sanitation for event attendees during the event including: adequate toilets, hand washing, and garbage and refuse containers. Will water be provided for food vendors? ☐ YES ☐ NO ☐ Vendor told to bring water If water is to be provided, what is the approved source? ☐ Private Well ☐ Public Water Supply* *If using a hydrant meter, you must contact the local utility to flush the line and place a meter prior to the event. Food grade hoses and splitters must be used. Will gray water disposal be provided for food vendors? ☐ YES ☐ NO If yes, indicate location: The final vendor list must be submitted at least 15 business days prior to the event. See page two for vendor information. PIC Signature: Date: SIGN ---PAGE BREAK--- Food vendors will not be issued permits for the event unless their individual permit application materials are submitted at least 3 days prior to the event. Please ensure all food vendors have a licensed retail food establishment, licensed commissary, licensed mobile unit, or concession trailer with a Certified Food Manager prior to accepting them for an event. If you have a vendor that will have more than one booth/tent at the event and will not be connected side-by- side, they must obtain a permit for each space. Please check if the vendor is a Home-Based Vendor (HBV). All HBV’s must comply with requirements of HEA 1149. Vendor List: Establishment Name Contact Person Phone Number E-Mail Food Items HBV ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐