2. Name of Applicant*
3. Name of Organization
5. Type of Organization*
   -- Select One --Commercial Business/For-Profit OrganizationCommunity OrganizationGovernment Organization/OfficeIndividual Loudoun County ResidentLabor UnionLoudoun County Staff/VolunteersNonprofitPolitical OrganizationOther
6. Description of organization
8. Street Address*
9. City*
10. State*
11. Zip*
13. Contact Person*
14. Phone number*
15. E-mail address*
17. Meeting Details
19. Requested Meeting Date*
    Requested Meeting Date

    Government Center rooms are only available Monday - Thursday.

20. Requested Meeting Start Time*
    Requested Meeting Start Time
21. Requested Meeting End Time*
    Requested Meeting End Time
    All meetings must end by 10pm.
23. Title of the Meeting*
24. Expected Number of Participants*
26. Where do you want to reserve a meeting space?*
    -- Select One --Animal Services FacilityEastern Loudoun Service CenterFire and Rescue FacilityGovernment CenterLoudoun County Public Library BranchPark and Ride LotParks, Recreation, and Community Services FacilityShenandoah Office BuildingSheriff's Office FacilityOther
28. Individuals who would like to rent/reserve facilities at Loudoun County Public Library should use the following link:
    • Library Meeting Rooms
29. Individuals who would like to rent/reserve facilities at Parks, Recreation, and Community Services or should use the following link:
    Parks, Recreation, and Community Services Facilities

    • Pavilions
    • Community Centers
    • Recreation Centers
    • Senior Centers
31. Name and Location of Other Facility Requested*
33. Do you plan to serve refreshments?*

    Food/drink are only permitted in certain rooms.

    1. Yes
    2. No
35. Name and Address of Park and Ride Lot *
36. List of Park and Ride Lots
    View list of Park and Ride Lots
38. Is this a public meeting (open to any member of the public to attend) or closed meeting (limited to invited guests only)?*

    1. Open/Public
    2. Private
    3. Other
39. Please describe.*
41. Signage/Flyers

    If you intend to put up signage or hand out flyers, please include examples.

42. Additional Documents
44. Additional Notes/Comments
46. Agreement

    I accept liability and hereby agree to indemnify and hold harmless Loudoun County, Virginia, its officers, agents and all employees and volunteers, from any and all claims for bodily injury, personal injury, and/or property damage in connection with the use of the facility. I accept responsibility for control of the area until the meeting is finished. I accept responsibility for complying with all Americans with Disabilities Act (ADA) requirements. I recognize that it is my responsibility to supply ADA required assistance for this event. I have read and agree to comply with the “Facility Use Policy.” The undersigned hereby certifies that he/she is authorized to execute this document on behalf of the organization requesting the use of the facility.
    
    

48. Facility Use Policy*

    1. I have read and understand the Facility Use Policy.
49. Applicant Signature *
    By typing your name in this box, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form.
50. Date*
    Date
52. Confirmation
    Your request will be reviewed and processed by county staff. You will receive an email to confirm your reservation.
Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field