Form 10-941 Application for a Permit to Conduct a Demonstration or S

(Rev. 04/2017) OMB Control No. 1024-0021

National Park Service Expiration Date XX/XX/2020

SUPPLEMENTAL INFORMATION FOR NPS FORM 10-941,

“APPLICATION FOR A PERMIT TO CONDUCT A

DEMONSTRATION OR SPECIAL EVENT IN PARK AREAS”

NATIONAL MALL AND MEMORIAL PARKS

Division of Permits Management

900 Ohio Drive, S.W.

Washington, DC 20024

Telephone: (202) 245-4715

FREQUENTLY ASKED QUESTIONS (FAQs)

Do I have to have a permit to conduct a demonstration or special event?

Yes, special events or demonstrations on parkland in the National Capital Region are governed by National Park Service (NPS) regulations found at 36 CFR 7.96.

How does the National Park Service define demonstration and special event?

While the definitions are fully detailed at 36 CFR 7.96(g)(1)(i) and (ii), the following two terms are defined in these instructions:

DEMONSTRATION generally includes speechmaking, picketing, vigils, marching or religious services etc., and all other like forms of conduct which is reasonably likely to draw a crowd or onlookers.

SPECIAL EVENT generally includes sports events, runs/races, parades, fairs, festivals or any activity which is not a demonstration.

Which form should I fill out if I want to hold a demonstration or special event?

NPS Form 10-941, “Application for a Permit to Conduct a Demonstration or Special Event in Park Areas”, available via the park’s website at www.nps.gov/nama¹, is used to request use of the following areas governed by NPS regulations:

National Mall and Memorial Parks Wolf Trap National Park for the Performing Arts

President’s Park Prince William Forest Park,

Rock Creek Park George Washington Memorial Parkway, and

National Capital Parks East A portion of Chesapeake and Ohio Canal National Historical

Manassas National Battlefield Park Park from Georgetown to the Monocacy River Aqueduct.

How early may I submit an application for a demonstration or special event?

Applications are accepted no earlier than one year in advance of the proposed demonstration or special event (including set up and take down).

What is the deadline to submit an application?

The NPS processes fully executed applications on a first-come, first-serve basis. The minimum submission time for applications is:

Activity Submission In Advance of Activity

Permit applications for demonstrations (First Amendment activities) At least 48 hours

Special events At least 48 hours

Waiver of numerical limitations for demonstrations at:

White House Sidewalk along Pennsylvania Avenue (over 750 persons) At least 10 days

Lafayette Park (over 3,000 persons) At least 10 days

How long does it take to obtain a permit?

Individuals and organizations are encouraged to contact the Division of Permits Management in advance of a proposed activity to determine if the space is already under permit to another group.

Upon receipt of your fully executed application, we will time and date stamp it as received, and then process it as rapidly as possible. A meeting may be necessary to discuss the details associated with your proposed activity. We look forward to working with you. If you have any questions, please contact the Division of Permits Management by telephone at (202) 245-4715.

Does the National Park Service make any special allowances for small groups who wish to demonstrate?

Demonstrations involving 25 persons or fewer do NOT require a permit, provided other conditions required for the issuance of a permit are met:

• The group may NOT merely be an extension of another group already availing itself of the 25-person maximum.

• The demonstration may NOT unreasonably interfere with other demonstrations or special events, and

• The group may NOT erect temporary structures (other than small lecterns or speakers’ platforms).

However,

• The use of portable signs or banners is NOT restricted.

Is the solicitation of money or funds for donation allowed on park property?

Pursuant to 36 CFR 7.96(h) the in-person soliciting or demanding of money or funds for donation on Federal parkland is prohibited, unless it occurs as part of a permit issued for a demonstration or special event.

• Persons permitted to solicit must not give false or misleading information regarding their purpose or affiliations or give false or misleading information as to whether any item is available without donation.

• Exacting a payment or requesting a donation in exchange for merchandise constitutes a sale and is not allowed unless it comports with the NPS sales regulation found at 36 CFR 7.96(k).

What types of items can be sold on park property in conjunction with a special event or public gathering?

Pursuant to 36 CFR 7.96(k) only the following items are permitted to be sold on park property in conjunction with a special event or demonstration: books, bumper stickers, leaflets, pamphlets, buttons and newspapers.

May foods be provided or sold during a special event or public gathering?

Food is generally available through the Park Service concessionaire. Only ethnic foods which are pre-approved by the National Park Service and that meet Public Health standards may be sold, but only if such foods are determined to be integral to the theme of the proposed event. Commercially packaged or generic beverages may not be sold. Please note that food service requires a separate 70 day application process pre-approved by the National Park Service and must meet Public Health standards.

Is it allowable to display and/or sell artwork during a special event or public gathering?

As part of a permitted event, ethnic arts and crafts may be displayed but may not be sold. If your event includes such a display or exhibit, an artisan should be actually onsite to demonstrate the production of the particular art or craft as part of your activity.

Does the National Park Service offer guidelines to review for special events or public gatherings?

Yes. While the National Capital Region’s “Requirements for Special Event Held on Parkland”² go into more detail, please note the following regarding costs associated with demonstration or special event applications:

Application Processing Cost:

• A one-time non-refundable application cost of $120.00 must accompany all SPECIAL EVENT applications.

• Special event applications will not be processed without the application processing payment.

• Payment is accepted by credit card, check and money order.

• FIRST AMENDMENT applications are NOT subject to the application processing cost.

No special event application will be processed unless processing cost remittance has been provided with the application. The application processing cost represents the average cost incurred by the park in receiving, processing, initially reviewing, distributing of applications to help ensure the information supplied is sufficient to inform a decision. Processing costs shall be reviewed each fiscal year.

Other Costs: There also may be charges for other costs associated with your proposed activity, incurred by the National Park Service and the United States Park Police. These charges are to reimburse the National Park Service for:

• Services,

• Resource damage caused by your activity, or

• Personnel deemed necessary to support your activity.

Depending on the size and scope of your proposed activity, a cost recovery deposit in the form of an irrevocable letter of credit, certified check, or money order, and/or documented liability insurance coverage may be required. Any costs will be discussed with the applicant, prior to issuing the permit.

United States Park Police Requirements:

Applications are also reviewed by the United States Park Police to determine if Park Police officers are required to be onsite for proposed event. If your event requires the service of the U.S. Park Police, you will be contacted directly by them to coordinate the appropriate arrangements. Payment for U.S. Park Police services must be made seven (7) days in advance of your event.

Are there special cost recovery requirements associated with demonstration or special event applications?

Cost Recovery Associated with Special Use and Public Gathering Permits:

• Government Accountability Office Report 5-410 requires agencies to more fully recover and collect costs associated with special use and public gathering permits

• Cost recovery program was implemented on October 1, 2006

• Initially included application processing costs, but now includes the recovery of additional costs associated with administration, management and monitoring of permitted activities

Monetary Cost Recovery Deposit:

Pursuant to long-standing practice, the NPS, National Capital Region, requires applicants to:

• Post a monetary cost recovery deposit prior to the event to cover costs incurred when NPS employees are required to work for event monitoring and for any needed site restoration following the event.

• The deposit amount is dependent on the size and scope of the event and will be discussed with the applicant before the permit is issued.

Where should I send my application?

Applications must be filed from 8:00 a.m. to 4:00 p.m., Monday through Friday (holidays excepted) at:

Division of Permits Management

National Capital Region

900 Ohio Drive, S.W.,

Washington, D.C. 20024

If I have additional questions, where should I call?

If you are unable to find the answer to your questions using these FAQs or in the “Requirements for Special Event Held on Parkland”, you may contact the Division of Permits Management for the National Capital Region of the National Park Service by calling (202) 245-4715. The office is open from 8:00 a.m. to 4:00 p.m., Monday through Friday (holidays excepted).

Are there any special considerations I should be aware of when I mail my application to the National Park Service?

Please note that as a security precaution, our incoming mail undergoes a treatment process before being delivered, which at times may significantly delay its arrival. Therefore, we strongly suggest that you use Federal Express, courier, or hand-deliver your application to us. Otherwise, the application will be delayed being received and time and date stamped and you may lose timely consideration.

				Date of Application:	     
SECTION 1: Contact Information
This is an application for a:
Demonstration Special Event Definitions on 10-941S, Supplemental Instructions
Individual/Organization				Telephone Number	Cell Phone Number			Fax Number
     				     	     			     
Email Address				Website
     				     
Street Address				City		State	Zip Code		Country
     				     		     	     		     
Person in Charge of Event				Telephone Number		Cell Phone Number
     				     		     
Email Address
     
Street Address				City		State	Zip Code		Country
     				     		     	     		     
At least one person must be listed as in charge of the activity. If different individuals are to be in charge of various activities at different locations, please list their names and contact information:
Name	Contact Information			Name		Contact Information
     	     			     		     
Name	Contact Information			Name		Contact Information
     	     			     		     
SECTION 2: Lafayette Park and White House Sidewalk
Is this an application for the use of the White House Sidewalk3 or Lafayette Park?
Yes No
Please be aware that a waiver of the numerical limitations is required if an expected demonstration on the White House Sidewalk will include more than 750 participants or that a demonstration in Lafayette Park will include more than 3,000 participants.
Is this an application for a waiver of the numerical limitations?
Yes No
SECTION 3: Event Logistics
Set-Up Dates and Times
Starting Date		Ending Date	Starting Time			Ending Time
     		     	      AM PM			      AM PM
Event Dates and Times
Starting		Ending	Starting Time			Ending Time
     		     	      AM PM			      AM PM
Break-down Dates and Times
Starting		Ending	Starting Time			Ending Time
     		     	      AM PM			      AM PM
Please list ALL proposed locations (include assembly and dispersal areas):
     

Estimated maximum number of participants for EACH PARK AREA TO BE USED (Including organizers, volunteers, participants and spectators):

     

Purpose of event:

     

Plan for proposed activity (include all speakers, a complete time schedule of the activity, proposed routes for any marches or parades, plans for the orderly termination and dispersal of activity which might affect regular flow of city traffic, etc.):

     

Please indicate any of these items that will be used during the proposed activity:

Handheld Signs/ Placards Quantity:      

Chairs Quantity:      

Tables Quantity:      

Tents Quantity:      

Portable Restrooms Quantity:      

Camera Tripod Quantity:      

Jumbotrons Quantity:      

Generators Quantity:       Type:      

Banner/Sign(s) Size: Length:       Width:       Height:      

Press Riser Size: Length:       Width:       Height:      

Stages Size: Length:       Width:       Height:      

Turf Protective Cover(s) Size: Length:       Width:       Height:      

Podium

Lighting Equipment

Estimated # of Buses:      

Distribution of Literature

Portable Sound System

Please list all other equipment (include any necessary medical/trailers ):

     

Are you proposing to solicit donations:

Are you proposing food or beverages service4:

Yes No

Yes No

Are you proposing road closures or traffic management? If so list the roads and/or trails affected? Yes No

     

How will the event be advertised or publicized:

Do you propose to have commercial sponsors? Yes No If yes, how are sponsors recognized.

TV

Print

Flyers

     

Radio

Website

Email/Listserv

Social media (Twitter, Facebook, Tumblr, etc.)

If boxes, crates, coffins, or similar items will be used, state whether they are to be carried opened or closed, their proposed size, the materials constructed from, and their proposed contents and use:

     

What are your cleanup and/or recycling plans?

How will cleanup members be identified?

     

     

SECTION 4: Activity Disruption

Do you have any reason to believe or any information indicating that any individual, group or organization might seek to disrupt the activity for which this application is submitted? Yes No

If “Yes”, list each such individual, group or organization and contact information for each:

     

SECTION 5: Marshals5 and Volunteers

Will applicant furnish marshals and/or volunteers? Yes No

How Many

Note: Marshals are required for all waivers of numerical limitations and for demonstration activities held simultaneously on White House Sidewalk and Lafayette Park.

     

List the functions the marshals and/or volunteers are expected to perform:

     

How will the marshals and/or volunteers be identified?

     

Person(s) responsible for supervision of marshals and/or volunteers (for each location):

Name(s)

Location(s)

Contact information during event (address/phone)

     

     

     

     

     

     

     

     

     

     

     

     

What communications equipment will be provided to the marshals and/or volunteers? (Include the number of walkie-talkies, mobile phone tree, bullhorns, public address systems, flashlights, etc.)

     

State specifically the plans for ingress and egress of the participants to and from all park areas including Lafayette Park. Please include proposed sites for loading and unloading of buses, automobiles or other forms of transportation which the participants are expected to use (supply chart or map if necessary).

     

SECTION 6: Permit Applicant Information (information for person completing application)
Name	Telephone Number	Cell Phone Number			Fax Number
     	     	     			     
Position	Email Address
     	     
Street Address	City		State	Zip Code		Country
     	     		     	     		     
Signature of Applicant			Date

APPLICATION IS NOT VALID UNLESS SIGNED

Hand deliver or mail completed application to:

National Park Service

National Capital Region

Permits Management Division

900 Ohio Drive, S.W., Washington, DC 20024

Office Phone: (202) 245-4715

Open 8:00 am to 4:00 pm, Monday – Friday

NOTICES

NOTE: This is an application only, and does not serve as permission to conduct any special activity in the park. The information provided will be used to determine whether a permit will be issued. Send the completed application along with the application fee in the form of a credit card payment, cashier’s check, money order or personal check made payable to the National Park Service to [input name/park office] at the park address found on the first page of this application.

If your request is approved, a permit containing applicable terms and conditions will be sent you. The permit must be signed by the responsible person and returned to the park for final approval by the Park Superintendent before the permitted activity may begin.

Customers Making Payment by Personal Check

When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment, and you will not receive your check back from your financial institution.

Privacy Act Statement

Authority: 54 U.S.C. §100101, National Park Service Organic Act; 16 U.S.C. 3, Rules and regulations of national parks, reservations, and monuments; timber; leases, 16 U.S.C. 3a, Recovery of costs associated with special use permits; and 16 U.S.C. 460i–6d, Commercial Filming.

Purpose: The purposes of the system are (1) to provide a park superintendent with information to approve or deny requests for activities that provide a benefit to an individual, group or organization, rather than the public at large; and (2) to assist park staff to manage the activity to ensure that the permitted activity does not interfere with the enjoyment of the park by visitors and that the natural and cultural resources of the park are protected.

Routine Uses: In addition to those disclosures generally permitted under 5 U.S.C.552a(b) of the Privacy Act, records or information contained in this system may be disclosed outside the National Park Service as a routine use pursuant to 5 U.S.C. 552a(b)(3) to other Federal, State, territorial, local, tribal, or foreign agencies and other authorized organizations and individuals based on an authorized routine use when the disclosure is compatible with the purpose for which the records were compiled as described under the system of records notice for this system.

Disclosure: Voluntary, however, failure to provide the requested information may impede individual from obtaining a permit from the National Park Service.

Information Regarding Disclosure of Your Social Security Number Under Public Law 93-579 Section 7(b): Your Social Security Number (SSN) is needed to identify records unique to you. Applicants are required to provide their social security or taxpayer identification number for activities subject to collection of fees and charges by the National Park Service. Failure to disclose your SSN may prevent or delay the processing of your application. The authority for soliciting your SSN is 31 U.S.C. 7701. The information gathered through the use of the SSN will be used only as necessary for processing this application and collecting and reporting any delinquent financial obligations. Use of the social security number will be carried out in accordance with established regulations and published notices of system of records.

Paperwork Reduction Act Statement

We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) and 36 CFR 7.96 (g) to provide the National Park Service with the required information necessary to decide whether or not to grant permission to conduct special events or demonstrations. All applicable parts of the form must be completed in order for your request to be considered. You are not required to respond to this or any other Federal agency-sponsored information collection unless it displays a currently valid OMB control number. This collection has been assigned Control No. 1024-0021.

Estimated Burden Statement

Public reporting for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Direct comments regarding this burden estimate, or any aspects of this form or instructions, to the Information Collection Clearance Officer, National Park Service, 12201 Sunrise Valley Drive, Mail Stop 242, Reston, VA 20192. Please do not send your application to this address.

Credit Card Authorization

All credit card information is protected under the Privacy Act of 1974

Applicant Name

Cardholder Name (as it appears on card)

     

     

Same as “Applicant”

Company Name (if applicable)

Telephone Number

Cell Phone Number

     

     

Email Address

Federal Taxpayer Identification or Social Security Number

     

     

Credit Card Billing Address

     

City

State

Zip Code

Country

     

     

     

     

Amount to be Billed to Card

Application Cost $     

Location Fee $     

Cost Recovery $     

Total $     

Type of Credit Card

Credit Card Number

Expiration Date

Security Code

American Express

Discover

MasterCard

Visa

     

     

     

I hereby authorize my card to be charged the amount indicated above in connection with the issuance of the requested Special Use Permit:

Cardholder Authorized Signature

Date

     

INTERNAL AGENCY USE ONLY

Project Number/BILL	Date Processed
     	     
Permit Number	Prepared By
     	     
Organization Name
     

¹ Special Use Application Form 10-930 for weddings, picnics, non-tournament specials; and Special Use Application Forms 10-931 Page i of iii

and 10-932 for filming and photography can also be obtained at www.nps.gov/nama