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Facility Use Application

  1. Meeting Details
  2. Rooms are only available Monday - Thursday.
  3. All meetings must end by 10pm.
  4. Will you be handing out materials?
  5. Do you plan to have a table?
  6. Would you like to serve refreshments?
    Refreshments are not permitted in the Board Room or in the Lobby.
  7. I accept liability and hereby agree to indemnify and hold harmless Loudoun County, Virginia, its officers, agents and all employees and volunteers, from any and all claims for bodily injury, personal injury, and/or property damage in connection with the use of the facility. I accept responsibility for control of the area until the meeting is finished. I accept responsibility for complying with all Americans with Disabilities Act (ADA) requirements. I recognize that it is my responsibility to supply ADA required assistance for this event. I have read and agree to comply with the “Regulations for Public Use of Facilities and Grounds at the Loudoun Government Center.” The undersigned hereby certifies that he/she is authorized to execute this document on behalf of the organization requesting the use of the facility.
  8. Facility Use Policy*
  9. By typing your name in this box, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form.
  10. Confirmation
    Your request will be reviewed and processed by county staff. You will receive an email to confirm your reservation.
  11. Leave This Blank:

  12. This field is not part of the form submission.