Name of Applicant or Representative: Phone: Address: City: State: Zip: Name of Organization Represented (if applicable): IRS Tax ID Number (if applicable): Title/Subject/Purpose of Activity: Number of Individuals Participating in this Activity: Category of Nonprofit Activity (check applicable): Government Private - County-Based Nonprofit Organization Private - County Employee Private - County Resident Requested Date and Time of Activity: First Choice: Date: From: To: Second Choice: Date: From: To: No helium-filled balloons are allowed in the Community Room. Will Advertisements/Brochures be distributed? Yes No. If Yes, fax a copy to the Hunter Mill District Office at 703-478-6847. Will Food/Drinks be served? Yes No. If Yes, describe: Will a fee be charged to participants? Yes No. If Yes, describe:
this form and start again.
For information about the use of the community room, see the Regulations for Public Use of Community Rooms at Fairfax County District Governmental Centers [PDF file].