Event Application

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Event Information
Area/County*
Form Completed By*
*
Date of Event Time of Event Date Form Submitted
Type of Event*
Expected Attendance*
# of Adults # of Children
Event Location*
Street Address Address Line 2 City State ZIP Code
Promotion
Payment Request
Payment Type
- Check Payment (invoice must be included)
- Credit Card Payment (invoice must be included)
Upload Invoice
Max. file size: 50 MB.
Payable To: Name
Address*
Street Address Address Line 2 City State ZIP Code
Phone
Amount
Send Check to
- embrella VC
- Payee
Service Explanation
If you have separate payment requests, please use the fields below.
Payment Type
- Check Payment (invoice must be included)
- Credit Card Payment (invoice must be included)
Upload Invoice
Max. file size: 50 MB.
Payable To: Name
Address
Street Address Address Line 2 City State ZIP Code
Phone
Amount
Send Check to
- embrella VC
- Payee
Service Explanation
Payment Type
- Check Payment (invoice must be included)
- Credit Card Payment (invoice must be included)
Upload Invoice
Max. file size: 50 MB.
Payable To: Name
Address
Street Address Address Line 2 City State ZIP Code
Phone
Amount
Send Check to
- embrella VC
- Payee
Service Explanation
INSURANCE REQUIRED – If yes, please submit Special Event Supplemental Questionnaire
Does Site Require Proof embrella Has Liability Insurance?
- Yes
- No
Submit completed form no later than 1 month prior to event!

Date of Event	Time of Event	Date Form Submitted

# of Adults	# of Children

Event Information

Promotion

Payment Request

INSURANCE REQUIRED – If yes, please submit Special Event Supplemental Questionnaire

Submit completed form no later than 1 month prior to event!