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2. Event
4. Date(s) and Time(s) of Event
   Date(s) and Time(s) of Event Start Date

   Date(s) and Time(s) of Event Start Time

   —

   Date(s) and Time(s) of Event End Date

   Date(s) and Time(s) of Event End Time
6. Purpose of Event
8. Contact Information
10. Applicant Name (Organization)
12. Name of Person Completing Application
14. Phone
15. Cell Phone
17. Email
19. Mailing Address
21. City
22. State
23. Zip Code
25. Location of Event
27. Long Answer
29. Noise Permit - Will you have amplified sound at your event?

    1. Yes
    2. No
31. If Yes, Please Describe
33. Expected Number of Participants
34. Expected Number of Spectators
36. Number of Officers Requested
38. Describe Police Services Requested
40. Why are you requesting police services rather than utilizing private security?
42. I understand I will be required to reimburse the Town of Jackson for having officers dedicated to this event at the rate of $65 per hour for each officer assigned to the event. Payment is due five days prior to the event and becomes non-refundable if the event is cancelled less than five days in advance. Make payments to the Town of Jackson c/o Jackson Police Department, P.O. Box 1687, Jackson, Wyoming, 83001.
44. Applicant Name
45. Date
    Date
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field