M-NCPPC Special Permit Request Form
Complete the following form then press
'Continue'
for your finalized application to print, sign, and mail, fax or hand deliver to M-NCPPC.
General Information:
Facility Name:
Day(s) of Week
Requested Date(s):
Total # of Hours
Time of Use
to
Fee:
Person in Charge :
Name of Oragnization/Group
(if applicable)
:
E-mail Address
Address :
City:
State:
Zip:
Work Phone:
Home Phone:
Description of Event:
Number of Attendance: Adults
, Teens
, Children
Fees: Admin.Fee:
, Additional Charges:
Payment Information:
Payment Method:
Select One
Cash
Check
Visa
Mastercard
Cardholder's Name
Card #:
Exp Date: