It will be the responsibility of the organization to provide personnel at EVERY blocked intersection to ensure that no vehicles enter or cross the designated route during the time of the closure. It will be the responsibility of the event organizer to notify all residents and businesses in the affected area of the closures. Failure to do so may result in future requests being declined.Name of Event* Sponsoring Organization* Organization’s Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Event:* Month Day Year End Date of Event:* Month Day Year Start and End Times* Location of Event / Route*Primary Contact Person* Telephone* Email Address* Enter Email Confirm Email Secondary Contact Person* Telephone* Email Address* Enter Email Confirm Email Event Description*City Services Requested*Streets to be Closed:Street Name Between (Street Name) Street Name Between (Street Name) Street Name Between (Street Name) From (time of start of closure) To (end time of closure) Additional InformationThis form must be submitted not less than 60 days in advance of the event.Upon approval, the organization must submit a Certificate of Insurance naming the City of Martinsville as an additional insured. If concessions or fund-raising activities are a part of this event, contact the City Clerk-Treasurer at 765-342-6012 regarding any necessary licensing; permits and/or additional insurance requirements.* On behalf of the applying organization, I have read the terms and conditions and by submitting this application, I and the organization accept and agree to the terms and conditions as stated.