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Showmobile Reservation Application

Complete and submit this form to reserve the Showmobile. Be sure to mail your payment if applicable (check or money order, payable to Fairfax County Park Authority) to Fairfax County Park Authority, 12055 Government Center Pkwy. Suite 927, Fairfax, VA 22035 Attention: Showmobile. Do not send cash through the mail. Please note that all fee payments are NON-REFUNDABLE. PLEASE READ ALL of the description, fees and reservation information.

Activity Date:
Type of Activity:
Name of Organization/Individual:
Phone:	(O) (C)
Address:
City:   State:   Zip Code:
Is your organization a non-profit?	Yes   No
Is your organization a government agency?	Yes  No
Is your agency located (based) in Fairfax County?	Yes  No
Delivery Address:
City:   State:   Zip Code:
Actual Program Hours: (example from 9:00am To 4:00pm)	FROM: TO:
Time Showmobile should be ready: (If different than program beginning time)
Time Showmobile should be removed: (If different than program ending time)
Additional Equipment Request (check items to include)	4' Platform Extensions 30 Folding Chairs Podium Portable Generator
Fee estimate:
Minus Deposit:
Net - Total:
The applicant accepts full responsibility for any and all damages to property caused by said user, and for the prompt and proper settlement of claims for such damages. In addition, the applicant agrees to assume responsibility for any legal liability for injury or damage to the person or property of the applicant or others in connection with the use of materials and/or equipment and agrees to save Department of Purchasing and Supply Management and the County of Fairfax harmless in the event of any injury or damage. Every effort will be made to have the Showmobile at the designated site on time. However, in the event of a vehicle breakdown, or if arrival is delayed for some reason beyond our control, the Dept. of Purchasing and Supply Management will not be held responsible. Use of the Showmobile is on a first come, first served basis.
Applicant :
Phone:	(O) (C)
Address:
City:   State:   Zip Code:
E-mail Address: