NPS Form 10-941 (Rev. 112020) (OMB Contot No, 1024-0021 atioeal Expiration Date 01/31/2024 APPLICATION FOR A PERMIT TO CONDUCT A DEMONSTRATION OR SPECIAL EVENT IN PARK AREAS NATIONAL MALL AND MEMORIAL PARKS Division of Permits Management 9 800 Ohio Drive, S.W. Washington, DC’ 20024 Telephone: (202) 245-4715 Date of Application: | 2-7/9 /3) [Demonstration |_|Special Event Definitions on 10-941S, Supplemental instructions _| UN. oundketton ane, 85° 2462 7 H es i Kur Camdabion.ocy a Count ass Person in Charge of Event (Sameas above | Telephone Number | Cell Phone Number ___ Kadam SOM < emai Adress Event Name Z - iy Siale | ZipCode ] Country ‘Breet Address ‘Al east one parson must be listed as in charge of the actully. [dllerent individuals are fo be in charge of vanous activites at diferent locations, please list their names and contact information (add supplemental sheot if more than two): ‘Name “Telephone Number Email Address (Org /Role of Responsibly Name “Telephone Number Email Address: ‘Org. /Role of Responsibility | SECTION: Latayate Parkand White House Sidewalk Ts this an applon forthe use of the White House Sidewel Yee [no PleGRE be aWa7e that a waiver of the numerical limitations is required ifan expected demonstration on the White House Sidewalk wit Include more than 750 participants or that a demonstration in Lafayette Park will include more than 3,000 participants. Is tis an application fora walvacof the numerical imitations? Loves Bano SECTIONS: Eventogisica or Lafayette Park? Aaivity Ends Breakdown, Completed Primary Date wip Da 3/170 Das Time: Pa Time: GAMER | Time: | FRsit]oat Lt oo dp “in 4:00) ‘llemate Date Date Date Date DAM GM | Time: Davo | time: CAME | time: Damcem Please list ALL proposed locations (include assembly and dispersal areas): Syn, Thaker grr hone Stay “The White House Sidewak is the sidewalk between East and West Executive Avenues, on the south aide PennsyWvanis Avenue, NIW, Page 1 of[NPS Form 10-941 Rev. 11/2020) ‘OMB Control No. 1024-0021, [National Park Service Expiration Date 0131/2024 ata wana ane parr os EAGT BARR AER TS BE URED (rchng OREN, OMRON, Papa ard * : Hepabelly 1,009 - 3,000 Fapaae Tae % Christin mess [Spratt sgantt mandi Te Conunys_o* Cancer . libby cnandite = De/ Plan for proposed activity (include all speakers, a complete time schedule of the activity, proposed routes for any marches or parades, plans for the orderly termination and dispersal of activity which might affect regular flow of city traffic, etc.): No Moshiy. our Mam « Speeches arthe orga . Handheld Signal Placards | — Chairs Tables Tents ges Qe y a Y O Size: 1o¥10 2G 5 | auantiy: Quantity: Quantity: Quantity. Portable Reston Camera Tr Jumbotrons| eneralors ay = _ O | Sie: 1 Quantity: 79-Heor Bes Quantity: Quantity: 2. Quantity: Type:__elertar Gy 322 cameron) Press Riser Stages Tur Peiedion Cover fae 32 ype: = Size: Size: Size: SEE lfd see, vere 10 Lote: O tee O free a8 Hea geo ‘width: Width: ‘Width: 3? ia Height: Height: Height: Hy & Podium’ C1 Lighting Equipment Bese F810 cistibuton of iterate Portable Sound System Please list all other equipment (include any necessary medicalfrailers ): “Are you proposing o salt donations: | Are you proposing food or bayerages service®. | Are you planning to cpngact a eales?® Oves Oyes No Dyes J INo ‘Are you proposing road closures or trafic management? If so, lst the roads andlor alls affected? [_]Ves [LYNo How wil the event be advertised or publicized yeu pronase corners rarest) vet ue ow O Print D Flyers CO. Radio CO Website CD Emaivtistserv Social media (Twitter, Facebook, Tumblr, et.) i7boxee, crates, cofns, o Snir Wom willbe used, sate whether thay ae Tobe card opened or dosed, ek proposed aie, he materials consnicted from, and thelr proposed contents and use: ne ‘What are your cleanup andior recycling plans? ‘How will cleanup members be identified? naa. ov sted he valedencs shaty + olan if 8 mys Page 20f6 5 Pease note there ls an addtional Temporary Food Establishment Permit Aplcation that must be completed atleast 70 days prior to proposed event. Food service is subject to more stringent standards including being preapproved by the National Park Service and ‘meaing Public Heath standards. Applicant must comply with NPS NCA Concession Contract regarding food and beverage services at an activ. ® ‘The only permitted tems forsale on parkland are books, newspapers, eats, pamphlets, butlons and bumper stickers.[NPS Form 10-94 (Rev. 1/2020) ‘National Pek Service (OMB Conte! No, 1024-0021, Expiration Date 01312024 activity for wich this application is submitted? Cl Yes i1-¥ee" ist each such individual, roup or organization and contac information for each oy ‘Bo you have any reason to believe or any information in ‘hat any individual, group or organization might seek to disrupt the yo re you lang fo cond cr desbortenaal_ ves BA No ‘Will applicant furnish marshals and/or volunteors? r= i a ‘Note: Marshals are required forall and for demoistration activites held ‘Simultaneously on White House Sidewalk and Lafayette Park. How Many ist the functions the marshals and/or volunteers are expected to perform: De we neoch fom? How wil the marshals and/or volunteers be identified? Viladers aaafte? Person(s) responsible for supervision of marshals and/or volunteers (Tor each location): Name(s) Location(s) Contact information during event (address/phone) Kyle fee Syl Thee yO phone tree, bullhoms, public address systems, flashlights, etc.) ‘What communications equipment will be provided to the marshals andlor volunteers? (Include the number of walkie-takjes, mobile ‘expected to use (supply chart or map if necessary). ‘Stale specifically the plans for ingress and egress of the participants fo and from all park areas including Lafayette Park. Please Include proposed sites for loading and unloading of buses, aulomobiles or other forms of transportation which the participants are 7 Marshals donot act s police, they help maintain order among participants, provide information to participants and nor-participants, Page of ‘Marshals should have knowledge of the overall event crganizaton,1NPS Form 10-941 (Rev. 1172020) (OMB Contot No, 1024-0021 Naina Park Service Expiration Date 0131/2024 APPLICATION FOR A PERMIT TO CONDUCT A a DEMONSTRATION OR SPECIAL EVENT IN PARK AREAS an NATIONAL MALL AND MEMORIAL PARKS Division of Permits Management £800 Ohio Drive, S.W. Washington, DC 20024 Telephone: (202) 245-4718 ‘SECTION 6: Permit Applicant Information (Information for person completing application) = ; Sean rp Ranbar | Fae an Kyle Sefak > ~ oS Found orien Cenceony % eee ‘(OIom 439 Sagat of at Date afirlar APPLICATION IS NOT VALID UNLESS SIGNED Fax and email submissions are not accepted. Hand deliver or mail completed application to: National Park Service National Capital Area Permits Management Division 900 Ohio Drive, S.W., Washington, DC 20024 Office Phone: (202) 245-4715 ‘Open 8:00 am to 4:00 pm, Monday — Friday Page 4016