Please DO NOT provide any personal or sensitive information when filling out this form, such as a social security number, credit card, health information, account number, etc. Applicant Information Contact Name First Last Mailing Address Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Phone Number Email Event Information Event Name Number Attending Event Type Rally Wedding Other… Date/Time Event Date Event Start Time Event End Time Does your event need an additional date or time? * yes no Additional Time Needed Usually for a Wedding Rehearsal Rehersal Date Rehearsal Start Time Rehearsal End Time All Events are to be Carried Out in Accordance with Code of State Regulations 35-1.050 I have read and agree to conditions of the Guidelines for use of the Carnahan Memorial Gardens. The facility manager may cancel an issued permit, even after the applicant has begun using the facility, and may remove the applicant from the facility if the application is false or incomplete or if the applicant fails to comply with the conditions specified in the permit. See attached pages of prohibited activities, policies and procedures for the State of Missouri (CSR 35-1.050) that must be followed. Guidelines for use of the Carnahan Memorial Gardens Confirmation By checking the box I attest that I understand the policies and procedures for use of state facilities and have supplied accurate information.