2. Applicant's Name *
3. Organization, Event, Group, Company, etc
5. Address 1*
7. City*
8. State*
9. Zip*
11. Age
12. Date of Birth
13. Driver's License #
15. Phone Number*
16. Email Address*
18. Reservation Date:*
20. Alcoholic beverages may not be sold or offered for sale. You may not charge any type of admission to your event. This permit may be revoked at the discretion of the designated Township Official to preserve the Public Peace and to enforce all of the laws of the State of Michigan as they apply to the consumption of alcohol. (ref. Sec. 19-57, Ord. #510)
22. The person making application for this permit and signing below will be held responsible for the actions of their guests. This program may be cited and charged under Michigan Statutes for any violations of the liquor laws relating to the consumption of alcohol by minors.
24. ** THE PERMIT HOLDER MUST SUPPLY A COPY OF CERTIFICATE OF LIABILITY **
26. Signature of person making the request*
27. Date
29. Do you agree?*

    By clicking I agree, you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I Agree
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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