Contact Information

Full Name: Cell Phone: Work Phone: Address: City: State: Zip: E-mail: Sponsored by: For Profit: YesNo

Event Information

Is this your first time using this online form?   YesNo How many forms do you plan to submit today?   Event Name: Event Start Date: End Date: Rain Date(if applicable): Event Start Time: AM PM   Event End Time: AM PM Area: - Select - Aldie Arcola Ashburn Bluemont Dulles Hamilton Hillsboro Lansdowne Leesburg Lovettsville Lucketts Middleburg Neersville Philomont Purcellville Round Hill South Riding Sterling Waterford Other Event Street Address: Type of Event (example: circus, parade, fair): Event Description: Anticipated Attendance:    Total:    Per Day: Anticipated Participants:    Total:    Per Day:

Supplemental Information

Select Yes No N/A Are you a professional/experienced event planner? Select Yes No N/A Is this event in cooperation with an organization? (ie: Town, Parks and Recreation, Mall) COMMISSIONER OF REVENUE & ECONOMIC DEVELOPMENT   Select Yes No N/A Is the event Sponsor/Organizer registered with the Office of Consumer Affairs at the Virginia Department of Agriculture and Consumer Services? Select Yes No N/A Does the Event Sponsor/Organizer have a Letter of Tax Exemption from the IRS? Select Yes No N/A Will any sales activity be conducted? Select Yes No N/A Will there be vendors traveling from outside of Loudoun County? Select Yes No N/A Will there be attendees traveling from outside of Loudoun County? HEALTH, ABC, SANITATION   Select Yes No N/A Will there be food vendors at your event? How many do you expect? Select Yes No N/A Will water be provided? Select Yes No N/A Will there be alcoholic beverages? Select Yes No N/A Is there a plan for trash disposal? If YES please specify: (1) number of trash cans; (2) number of dumpsters; (3) collection frequency; (4) contact information for trash collector Select Yes No N/A Is there a plan for collecting recyclables? If YES please specify: (1) what will be collected for recycling; (2) number of recycling bins; (3) number of dumpsters; (4) collection frequency; (5) contact information for recycling collector (max 400 characters) BUILDING AND ZONING   Select Yes No N/A Will the event include any mechanical rides, moon-bounces, et cetera? Select Yes No N/A Will the event be open or advertised to the public? Select Yes No N/A Will the event have amplified music? PUBLIC SAFETY   Select Yes No N/A Will tents be erected larger than 20 X 20? Select Yes No N/A Will there be any use of fireworks, lasers, black powder or other pyrotechnics? Select Yes No N/A Will any streets need to be closed? Select Yes No N/A Will vehicular traffic be entering or exiting onto public road/roadways? Select Yes No N/A Will traffic be blocked or rerouted? Select Yes No N/A Will there be onsite camping? Select Yes No N/A Are animals involved in any aspect of your event? Select Yes No N/A Have you contacted a Fire and/or EMS provider for your event? If YES what company will be providing fire and/or EMS support for your event? If NO we will provide you with contact information for your local volunteer fire and rescue company. (max 400 characters) Special Notes or Questions: (max 600 characters)