OMB No. 0518-0024
Expiration Date xx/xx/xxxx
U.S.
NATIONAL
ARBORETUM
REQUEST for USE of ARBORETUM FACILITIES APPLICATION and AGREEMENT
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? No Yes
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) and/or location(s).
Submit Form Electronically
FOR OFFICE USE ONLY
Recommended Approval: Yes No If no, reason Signature Title Date Signature Title Date
Administration
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.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the following address: U.S. Department of Agriculture, Agricultural Research Service, Research, Education, Economics, Administrative Financial Management, Information Technology Services Division, 5601 Sunnyside Ave., Beltsville, MD 20705, ATTN: PRA (0584-0024). Do not return the completed form to this address.
Form Updated 11/6/24
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18 Available
12 Available
72' X 18'
Rectangle Table
72' Rouna Table
AUDITORIUM
72' X 30'
Rectangle Table
RM #119
12 Available
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Facilities Use Form |
Author | Ramon Jordan |
File Modified | 0000-00-00 |
File Created | 2025-02-12 |