Description:

Description:

Community Room Reservation Form

Description:

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FOR NONPROFIT PURPOSES.


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 Contact Form

this form and start again.

As with all correspondence received by the Board of Supervisors, the content of your message, including your name, address, phone numbers and E-Mail address, are subject to disclosure under the provisions of the Virginia Freedom of Information Act, and if requested must be provided.

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].



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Last Modified: Thursday, June 30, 2011