Type of Activity _________________________________________________________

Date ____________________ Hours ________________________________________

Location or event route ___________________________________________________

(A map showing the location or event route must be submitted with the application.)

Estimated Number of Participants_________ (The final number will be at the discretion of the Town Board based upon safety issues and special circumstances of each event along with recommendations from the County Sheriff's office.)

Sponsoring Organization _________________________________________________

Address ___________________________________ Telephone __________________

Onsite Manager or Person in Charge:

Name____________________________________________________

Address __________________________________________________

Telephone________________________ Fax_____________________

Applicant Signature_________________________ Date____________

Permit Fee $25.00

The activity area (roads, right-of ways and other public areas) are to be left free and clean of all trash and debris, including road markings, (paint cannot be used), and (2) if the following terms and conditions are fully met:

1. The application shall be submitted 120 days in advance of the event to allow time for the County Sheriff's office to review the application and time for the Town Board to review their response.

2. The sponsoring organization shall give proof of liability insurance coverage of at least 2 million dollars prior to the issuance of the permit.

3. There shall be no timed or race events allowed on Town roads.

4. Each participant in a road activity shall have a visible license plate or a number visibly displayed on their lower back.

5. Residents adjacent to the location or along the event route shall be notified of the event in writing at least three days in advance of the event providing times of inconveniences.

6. Sponsoring organizations shall provide assurance that traffic delays will be held to a minimum.

7. All participants shall comply with the governing rules of bicycling on public roadways in Section 346.80 of the Wisconsin State Statutes. Of particular concern is 346.80 (3) (b) which states: "Persons riding bicycles upon a roadway may not ride more than 2 abreast except upon any path, trail, lane or other way set aside for the exclusive use of bicycles. .. .

Please return the application to:

Town of Vermont
4017 County Tk JJ
Black Earth, WI 53515