National Arboretum Fees for Service for the Grounds and Facilities as Well as Commercial Photography and Cinematography. (State, Local or Tribal Government)

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)___________________

1. Is this a fundraising event? No_____ Yes_____ If yes, explain how funds will be raised:_____

_____________________________________________________________________________

2. Will there be an attendance / registration or donation fee collected on site? Yes_____ No_____

3. Will there be a sale or auction of products or services? No_____ Yes (specify)______________

_____________________________________________________________________________

4. Will food be served? No______ Yes______

5. Will caterers be used? No _____ Yes_____ If yes, vendor name__________________________

6. Is your vendor licensed and insured? No_____ Yes_____ License umber___________________

7. Will vendors be used to provide equipment for the event? No_____ Yes_____ If yes, vendor name__________________________

8. Is your vendor licensed and insured? No_____ Yes_____ License umber___________________

9. 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

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