Banner Request Application
Note: No request for placement of a banner on municipal property is complete until a signed, original of this form is received and approved by the Board of Selectmen. Please make a copy of this form for your files before submitting it and confirm with the staff that the Board of Selectmen has acted upon it before proceeding.
1. Name of Organization/Individual: The full name of the organization or individual seeking to place a banner on municipal property.
________________________________________________________________________
2. Address of Organization/Individual: The organization or individual has a principal place of business or residence at the following address:
________________________________________________________________________
________________________________________________________________________
Telephone No: ______________________________ e-mail ______________________
3. Local sponsor: The following resident of Monson, Massachusetts who has signed below as “Sponsor” affirms that the requested banner and its placement on municipal property has a civic, educational, philanthropic, economic or recreational purpose with a substantial value to the community:
By: ___________________________________ Name:________________________
Address: ______________________________ Telephone No.: _________________
Monson, MA 01057
4. Wording on Requested Banner:
________________________________________________________________________
It is recommended to attach picture or drawing of the proposed banner showing all measurements and colors.
5. Effective Dates Requested: ______________________________________________
6. Emergency contact from sponsoring organization (name and telephone number):
________________________________________________________________________
7. Release:
In consideration of the use of municipal property for the installation of its banner, the undersigned organization for itself and each and all of its members, hereby releases, remises and waives any and all claims which they, or any of them, ever will or may have against the Board of Selectmen, the town of Monson and/or its employees for any injury to persons or damage to property suffered as a result of its banner installation, except insofar as such injury or damage is directly and solely caused by the gross negligence or intentional misconduct of any person belonging to or acting on behalf of the Board of Selectmen, the town of Monson, or its employees.
I hereby acknowledge receipt of a copy of the Town of Monson’s Policy for Placement of Banners on Municipal Property and agree to the conditions set forth in it.
Requesting person, on behalf of organization: _______________________________
Signature
_______________________________________
Date
Action Taken:
Approved _________
Denied _________
Board of Selectmen
____________________________________________
____________________________________________
____________________________________________
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