Laserfiche WebLink
Page 4 of 4 <br />Revised: 12-28-17 <br />IN WITNESS WHEREOF, THIS WAIVER, RELEASE AND INDEMNIFICATION <br />AGREEMENT is executed by the special events holder, acting by and through the undersigned, <br />who represents that he or she is properly authorized to execute the same and bind the Special <br />Events Holder hereto. <br />PRINTED NAME OF SPECIAL EVENTS HOLDER: <br />PRINTED NAME AND TITLE OF PERSON SIGNING ON BEHALF OF SPECIAL <br />EVENTS HOLDER: <br />Name: -j 4 /W <br />Title: ✓i'✓� /11� %O� ; l L<'G % �� f' <br />Signature: <br />1007 <br />Date: 4ZZ / <br />/4' <br />S:\Administration\Licenses\Special Event Permits\Release Indemnification Agreement 12-28- <br />17.docx <br />