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OMB Control No. 1024-0021 PS Form 10241 (er. 042047) Naina Put Seve ‘apne Dae 013220 — APPLICATION FOR A PERMIT TO CONDUCT A = DEMONSTRATION OR SPECIAL EVENT IN PARK AREAS : NATIONAL MALL AND Wi isin of Potts legen 5 900 Ohio Drve, &.W. astington, DC’ 20024 Tolan aeice (O02) 245-4715 Y ay RSG Tomatoes [T5408 ‘SECTION 1:" Contact torreon ~ “hig an application for | S4Demonstaton [1 Special Event Definléons on 10-0415, Supplemental instructions individualOganizalicn ame, Telephone Number — [Cal Fax Nuiber etree WiScatt [ere Cee deye a! : Email Address Wenate | = —— — Gellruw MECaLL 7 Ei 5 ~ —__ —_ ei | “Atloast one porson must be fstod as in charge ofthe actly. +». ~ aw CPM {oc Dam Efem ‘Event Dales and Times Storing Ending ‘Staring Time Enaing Time sls) dog Sly)aue [o's OAM PM 330 aM Eto. ‘Broak down Dates and Times Staring ning Starting Time Ending Time SIs} aa¢ Sls'Jaa% 30 Clam Pm Can tou | Please Bet AL proposed location (nclode assembly and deparsal amas) oe Vota Hee TK Sylean rate arta, We Gadd asp mln 9 ge Then oF ZB wt Wet Cntte cened walle Hee eit Soteleers os ( coach rand nine From Amedeo Sidiwatle reo’ monument fe etek tee "The White House Sidewalks the skiewak between East and Weat Execuive Avenues, onthe south side Penneyivania Avenue, MW. Page 1ol6 LEAR NPS Foam 10-941 (Rev. 082017) (OMB Conte! No. 1026-021 ‘Nasal Pu Service ‘xpincion Dato 8/3/3000 Estimated maximum number of paricibants for EACH PARK AREA TO BE USED (indlding organizers, volunteers, paricipanis and soon! @y s PEP em at eee ksh mente Of being Articnel fom Vio by Sows Choe» romesexral | tronsqendk © Pian for proposed activity (Include ali speakers, a completa ime schedule of the activity, proposed routes for any marches or plans for the ord ‘and dispersal of vahich might eifect reGeiar how of ely talc oc). . (ae Peey ECA eA Vins LIKE) WAQO NZ seek gyovger meee” SC Edword Byed) Vaese Se eg (we SEY of Tinta Sone Pecan hain 7 ic H paste F10_- ee od Quant: uantiy: is 2 me Oey o con ons o sr ue alec Prose Riser Te 5 3 ‘Size: ‘suo: = "eta Got 3 Lona 3 A OF fenath: o Sy, 5 2 width: 24 wa tages . 7 Height: 944+ ~ vent: © Pesan T Uigheng Equipment . Helge C1 Distribution of Literature | []_ Portable Sound System C1 Estimated # of Buses: ‘Pieaae lista other equipment (inclide any necessary medicalfrallers ): 3 Wires emi ceagheneS oc peatene > Lemont bac Sere sak s. TH? See BS eiereguene seed e TS enti Lenk | Ane ‘Are you proposing to solicit donations: Are you proposing food or beverages | i Des Bitte Dyes 7s you proping Td cates or wate anager? eo Fak tho rad ender Was affecied?” (1 Yoo how ite vot bo avarood on panacea laugh Saal Cee Mi ow Print Drees ° Cl Reco 1D Webste I emawtistsery [Social media (Ter, Facebook, Tumble.) 1 boxes, ios, cof, oF Slr Roma wl b weed, date whalbor hay aro tobe cared oped cised, dar proposed ez, the materials constructed from, and their proposed contents and use: ‘What are your dearup andlor recyelig plang? iow will Geanup members be Mertiied? Clem? poor (ROT sheets. vase wh ‘4 Please note there is an edfitonel Temporery Food Establishment Permit Applicaton that must be completed at east 70 days rar Page 2016 ‘o proposed event Food servic subject b moro eringent standards inelung belagpreapproved by the Nafonal Park Service and ‘esting Putte Health standards. Only tine foods that aredetermiiod 1 be infogra ta the tare ef the proposed evant ars ported. (OM Conta Mo. 10240124 15 Form 10941 er 082017) Nanni at Senice xpiata Dae 0831200 [ SECTION. RedityDierupaon ‘Do you have any reason to believe or any information ir that any individual, group or organization might seek to disrupt the ‘activity for which this application is submited? [1 Yes. 11Yes" list each such individual, graup or organization and contact information for each: ‘SECTION &: Worehels* and Volunteers ‘Wil epplicant umish marshals andior vaunioos? —TYes CT No Tow nian Note: Marshols or routed forall waivers of aumericlEniatons and for demeneiraton activites hold 3 -simultaneousty on White House Sidewalk and Lafayotte Park. Tt te Tuncons the marshals andor volunteers aro expacid to perfor Bvelmbers te ble set og and dear down titer and clean UP ‘How will the marshals and/or volunteers be identified? bohte TT shiets Person(s) responsible for supervision of marshals andor volunteers (for sach tocation}: Nome(s) Location(s) ‘Contact information during event {adress/phone) [ Dethres one cast | Sylver Tre cstce oor | t ‘What corimunicationé equipment wil be provided bo the marshals and/or voluntaora? (Include the number of walkie talkies, mobile phone tree, bullhoms, public address systems, flashlights, et.) Net ‘Stale spedically the plans for ingress and egress of ihe paricipants to and from all park areas including Lafayelle Park. Ploase Include proposed sites for ioading and unioading of buses, automobiles or other for of traneportation which the participants are pected to (euply carte ep # recone We LAL (aad and Unload

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