U.S. NATIONAL ARBORETUM
REQUEST for USE of ARBORETUM FACILITIES APPLICATION and AGREEMENT
One Request Per Sheet, Please Print.
Contact Name:_________________________________________Date:_________________________
Organization Name:__________________________________________________________________
Mailing Address:____________________________________________________________________
Telephone: Home_________________Work_____________________Cell______________________
Email Address: _____________________________________________________________________
Requested Date:____________________Purpose:__________________________________________
__________________________________________________________________________________
Set up time: From _________To________ Actual program/event time: From _________To_________
Break down and clean-up time: From __________To__________ Total # Hours __________________
Estimated Attendance: ________________________________________________________________
Indoor Facilities Requested: Outdoor Facilities Requested:
______Administration Building Auditorium ______East Terrace
______Administration Building Classroom ______North Terrace
______Administration Building Lobby ______Flowering Tree Walk Tent Site
______Other (specify)____________________ ______Meadow Tent Site
______Other (specify)___________________
Is this a fundraising event? No_____ Yes_____ If yes, explain how funds will be raised:_____
_____________________________________________________________________________
Will there be an attendance / registration or donation fee collected on site? Yes_____ No_____
Will there be a sale or auction of products or services? No_____ Yes (specify)______________
_____________________________________________________________________________
Will food be served? No______ Yes______
Will caterers be used? No _____ Yes_____ If yes, vendor name__________________________
Is your vendor licensed and insured? No_____ Yes_____ License umber___________________
Will vendors be used to provide equipment for the event? No_____ Yes_____ If yes, vendor name__________________________
Is your vendor licensed and insured? No_____ Yes_____ License umber___________________
Will permission be requested to serve beer &wine? No_____ Yes_____
I request to use the facilities indicated for the period and purposes indicated. I understand the use of these facilities is subject to all rules and regulations listed in “The Code of Federal Regulations” (CFR) #7 CFR Part 500 and attached Facility Use Guidelines. The Facilities I have requested may be needed by the Department of Agriculture or the USNA; in this event, my organization may be asked to change the program date(s).
______________________________________________________________________________
Signature of Applicant Date
FOR OFFICE USE ONLY
Recommended Approval: Yes_____ No_____ If no, reason___________________________________
Signature _____________________________Title ____________________Date ______________
Signature ______________________________Title _____________________Date _______________
Administration
Confirmation sent on: ___________________________________Date:____________________
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0518-0024. The time required to complete this information collection 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
Form Updated 7-14-2015
File Type | application/msword |
Author | Lindsay Hicks |
Last Modified By | Anderson, Yvette |
File Modified | 2015-07-20 |
File Created | 2015-07-20 |