National Park Service, National Capital Region Applicati

Paperwork Reduction Act & Privacy Act Statement: In accordance to 36 CFR 7.96 (g), this regulation gives us the authority to require applicants to fill out this form to request permits for special events or demonstrations. A Federal 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. Confidentiality of this information is assured subject to the provisions of the Freedom of Information Act. Additional disclosures of the information may be to the United States Park Police, the District of Columbia Metropolitan Police Department, and any other affected law enforcement agencies.

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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Chief of Park Programs Division, National Park Service, National Capital Region, 1100 Ohio Dr., S.W., Washington, D.C. 20242.

OMB CONTROL NUMBER: 1024-0021 EXPIRES: 06/30/07

NATIONAL PARK SERVICE, NATIONAL CAPITAL REGION

APPLICATION FOR A PERMIT TO CONDUCT A DEMONSTRATION OR

SPECIAL EVENT IN PARK AREAS AND A WAIVER OF NUMERICAL

LIMITATIONS ON DEMONSTRATIONS FOR WHITE HOUSE SIDEWALK*

AND/OR LAFAYETTE PARK

___________________

Date of this Application

1. Individual and/or organization sponsor(s): ____________________________________

______________________________________________________________________

Address: ______________________________________________________________

Telephone Nos. (include area code): Day _______________ Evening _______________

2. This is an application for a permit to conduct a DEMONSTRATION _______________

SPECIAL EVENT ____________. (For definitions, see instruction page.)

3. This is an application for a WAIVER OF THE NUMERICAL LIMITATIONS on certain demonstrations. YES ____ NO ____ (A waiver is required if it is expected that a 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.

4. Date(s) of proposed activity: From __________________ To __________________

Month/Day/Year Month/Day/Year

Time: Begin: ____________(a.m.)(p.m.) Terminate: ____________(a.m.)(p.m.)

5. Location(s) of proposed activity. (Include assembly and dispersal areas.)

6. Purpose of proposed activity: _______________________________________________

7. Estimated maximum number of participants. (If more than one park area is to be used, list numbers separately for each area.) __________________________________

*(The "White House Sidewalk" is the sidewalk between East and West Executive Avenues, on the south side of Pennsylvania Avenue, NW.

8. Will cleanup people be provided for the area: ____YES ____NO. How will they be identified? _____________________________________________________________

9. Person(s) in charge of activity. (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, each must be listed.)

Person in charge: _____________________________________________________

Address: ____________________________________________________________

Telephone Nos. (Include area code): Day______________ Evening ______________

10. Plans for proposed activity. (Include a list of all principal speakers and the complete time schedule for the activity. Include proposed route of any march or parade, and plans for the orderly termination and dispersal of the proposed activity which might affect the regular flow of city traffic.) ________________________________________

11. (a) List all props, stages, sound equipment, and other items to be provided by applicant/sponsor. (Include approximately number and size(s) of supports, standards, and handles; necessary medical/sanitary facilities and other similar items.) __________

(b) 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. _______________________________________________

12. (a) 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

2. If "YES," list each such individual, group, or organization, with all information as to each, including address and telephone numbers.

_____________________________________________________________________

13. MARSHALS: (a) Will applicant/sponsor furnish marshals? (Required for waivers of numerical limitations and for demonstration activities held simultaneously on White House Sidewalk and Lafayette Park.) ____YES ____NO. If "YES," how many marshals will be furnished? _______________________________________________________

2. Person(s) responsible for supervision of marshals (for each location):

Location(s): __________________________________________________________

Name(s): ____________________________________________________________

Address(es): __________________________________________________________

Telephone Nos.: Day: ____________________ Evening: ____________________

2. List the functions the marshals are expected to perform: __________________

QUESTIONS 14, 15 AND 16 MUST BE ANSWERED IF THIS IS AN APPLICATION FOR A WAIVER OF NUMERICAL LIMITATIONS. IF THIS IS NOT AN APPLICATION FOR A WAIVER, DO NOT ANSWER THESE QUESTIONS.

14. What communications equipment will be provided to the marshals? (Include the number of walkie-talkies, CB radios, bullhorns, public address systems, flashlights, etc.)

15. How will the marshals be identified? _________________________________________

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

_____________________________________________________________________

APPLICATION IS NOT VALID UNLESS SIGNED

__________________________ ______________________________

Position of person filing application Signature of person filing application

___________________________ ____________________________________

Typed or printed name of person Address of person filing application

Filing application

Telephone Nos. of person filing application (include area code):

Day: ________________________ Evening: ________________________