Special Event Connection Form

Event name

Setup date

MonthDayYear

Setup time

Hour Minutes

AM/PM Option

Removal date

MonthDayYear

Removal time

Hour Minutes

AM/PM Option

Locations requested

Note: See locations of Civic Center Park Eclipse 85 hydrants. See location of City Park Eclipse 85 hydrant.

Contact Name

First NameLast Name

Billing Address

Street Address

Suite, unit, apartment number, etc.

CityState

ZIP Code

Contact's phone number

Please enter a valid phone number.Format: (000) 000-0000.

Contact's email address

Confirmation Emailexample@example.com

Nonprofit name, if applicable

Briefly describe event type and event location

Briefly describe water needs for event

Briefly describe the nonprofit benefiting from this event, if applicable

Please verify that you are human

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