Today's Date:

    Name of Organization/Group:

    Type of Organization:

    Event Description:

    Event Date(s):

    If multi-day event, please select the number of days:

    If this is a recurring event, please list details below:

    Start time (include set-up time):

    End time (include clean-up time):

    Primary Organizer/Contact:

    Contact Phone:

    Contact Email:

    Is the event open to the public? YesNo

    Estimated Number of Attendees (max 56):

    Will food or beverages be served? YesNo

    Do you need to use the room’s audiovisual equipment? YesNo

    *If this is your first time using the AV system, you are required to schedule a brief AV training with TJPDC.


    NOTE:


    Is the event sponsored by City of Charlottesville Neighborhood Development Services, Albemarle County Community Development, JAUNT, CAT or TJPDC?

    YesNo

    If yes, please include the information below for the authorizing agent

    Name of Contact:

    Contact Phone:

    Contact Email: