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Please return to: Town of Minden 1604 Esmeralda Ave. Suite 101 Minden, NV 89423 Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] TOWN OF MINDEN CVIC HALL APPLICATION AND USE PERMIT This application and deposit must be on file in Town of Minden in order to guarantee facility rental. Name of Organization / Contact Person Date(s) of Rental Type of Activity to be conducted: First Time Rental? Yes No Primary phone: Secondary phone: Email Address: Mailing Address: and Zip Code Physical Address: and Zip Code Requested opening time Requested closing time Total hours Anticipated Number of People CVIC HALL AMENITIES Mark all that will be needed for your event: Upstairs Meeting Room (Additional charge) Dumpsters Kitchen Audio-Visual Screen* Stage Lights Microphones; If so, how many? Computer connection* IPod Connection CD Player Other Special Needs: *Note: If you are using DVDs or computers, please bring them with you when you arrive. The person operating these must also be present. Our Facilities Staff will be available to help you set up at that time. If the Facility Staff have to return later, there will be a call back fee of $25. Thank you! ***The Hall must be cleaned and vacated by midnight. Town Staff will come to lock up at midnight if not contacted prior to that time, and the renter will be billed for the cleaning efforts of Town Staff. APPLICANT CERTIFIES RECEIVING THE CVIC HALL POLICIES AND PROCEDURES AND AGREES TO ABIDE BY ALL PROVISIONS THEREOF. APPLICANT/RESPONSIBLE PARTY MUST HAVE A COPY OF THIS APPLICATION DURING THE CVIC RENTAL. Policy Received: Date: Signature For official use only Is the deposit name/address different than above? Yes No Amount of Name on Deposit Check / Credit Card: Address on Deposit Check/CC Billing Address: Will the activity involve alcohol consumption? Yes___ No___ If yes, will alcohol be sold? Yes___ No___ If alcohol is to be sold, a permit must be obtained from the Sheriff's Office at [PHONE REDACTED]. Will the activity involve selling food? Yes___ No___ If food is to be sold, please contact the Health Department at [PHONE REDACTED] for permit requirements. Is this event open to the public? Yes No If so, what time does the event start? Please fill out the Public Events Website Information Sheet. **If this is a public event with multiple days, please fill in the back page with times for each day.** ---PAGE BREAK--- Please return to: Town of Minden 1604 Esmeralda Ave. Suite 101 Minden, NV 89423 Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] TOWN OF MINDEN CVIC HALL APPLICATION AND USE PERMIT For Multiple Days and Times Date of Event for the Public: Doors Open to the Public at: am / pm Event/Show Starts at: am / pm Event/Show Ends at: am / pm Date of Event for the Public: Doors Open to the Public at: am / pm Event/Show Starts at: am / pm Event/Show Ends at: am / pm Date of Event for the Public: Doors Open to the Public at: am / pm Event/Show Starts at: am / pm Event/Show Ends at: am / pm Date of Event for the Public: Doors Open to the Public at: am / pm Event/Show Starts at: am / pm Event/Show Ends at: am / pm Date of Event for the Public: Doors Open to the Public at: am / pm Event/Show Starts at: am / pm Event/Show Ends at: am / pm Date of Event for the Public: Doors Open to the Public at: am / pm Event/Show Starts at: am / pm Event/Show Ends at: am / pm Date of Event for the Public: Doors Open to the Public at: am / pm Event/Show Starts at: am / pm Event/Show Ends at: am / pm Date of Event for the Public: Doors Open to the Public at: am / pm Event/Show Starts at: am / pm Event/Show Ends at: am / pm Date of Event for the Public: Doors Open to the Public at: am / pm Event/Show Starts at: am / pm Event/Show Ends at: am / pm Date of Event for the Public: Doors Open to the Public at: am / pm Event/Show Starts at: am / pm Event/Show Ends at: am / pm