Please DO NOT provide any personal or sensitive information when filling out this form, such as a social security number, credit card, health information, account number, etc. Applicant Information Contact Name * Mailing Address * City * State * -Select-AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Phone Number * Email * Event Information Event Name * Number Attending * Event Type * Rally Wedding Other... Event Type Other... Date/Time Event Date * Year Year20172018201920202021 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Event Start Time * Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Event End Time * Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Does your event need an additional date or time? * Yes No Additional Time NeededUsually for a Wedding Rehearsal Rehearsal Date * Year Year20172018201920202021 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Rehearsal Start Time * Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Rehearsal End Time * Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm All Events are to be Carried Out in Accordance with Code of State Regulations 35-1.050 * The facility manager may cancel an issued permit, even after the applicant has begun using the facility, and may remove the applicant from the facility if the application is false or incomplete or if the applicant fails to comply with the conditions specified in the permit. See attached pages of prohibited activities, policies and procedures for the State of Missouri (CSR 35-1.050) that must be followed. Guidelines for use of the Carnahan Memorial Gardens I have read and agree to conditions of the Guidelines for use of the Carnahan Memorial Gardens. Confirmation * By checking the box I attest that I understand the policies and procedures for use of state facilities and have supplied accurate information.
