Expressive Activity
Permit Application
INSTRUCTIONS
PRINT, SIGN, SCAN, AND EMAIL THE COMPLETED FORM TO
DullesPermitApp@MWAA.com or ReaganPermitApp@MWAA.com
Applicant (Individual or Organization) information
Name PROVIDE FULL NAME OF INDIVIDUAL OR ORGANIZATION
Mailing address PROVIDE FULL ADDRESS OF INDVIDUAL OR ORGANIZATION
Email address PROVIDE EMAIL OF APPLICANT Phone number PROVIDE PHONE OF APPLICANT
Information regarding proposed Expressive Activity
1. Description of proposed Expressive Activity SELECT ONE OF THE ACTIVITIES BELOW.
Distribution of Printed Material
1/
Sale of Printed Material
2/
Demonstration Solicitation
2/
2. Airport of proposed Expressive Activity SELECT WHICH AIRPORT THE PERMIT IS FOR. YOU MUST COMPLETE A
SEPARATE APPLICATION FOR EACH AIRPORT.
Reagan National Dulles International
3. Designated Area(s) for the proposed Expressive Activity
3/
REVIEW SECTION 6.F OF O&I 7-6-1 AS WELL AS
ATTACHMENTS A & B OF THE O&I FOR DESIGNATED AREAS.
4. Date and times requested for the proposed Expressive Activity
4/
MUST PROVIDE A SINGLE DATE WITH START
AND END TIMES. IF SEEKING PERMITS FOR MULTIPLE DATES AND TIMES, YOU MUST SUBMIT SEPARATE PERMIT
APPLICATIONSF OR EACH DATE AND TIME.
Date Start time End time
5. Names of each Individual who will participate in the proposed Expressive Activity
5/
(provide in the attachment
to this application form) IF MORE THAN THE APPLICANT LISTED ABOVE, YOU MUST INCLUDE THE NAMES OF
EACH INDIVIDUAL WHO WILL PARTICIPATE IN THE PROPOSED EXPRESSIVE ACTIVITY. PROVIDE THEIR NAMES
ON THE ATTACHMENT TO THE APPLICATION.
Information regarding individual signing this application on behalf of the applicant
6/
THE INDIVIDUAL
SIGNING MUST PROVIDE THEIR NAME, EMAIL AND CELL PHONE TO BE REACHED ON THE DAY OF THE
PROPOSED EXPRESSIVE ACTIVITY. EVEN IF LISTED ABOVE, THIS MUST BE LISTED AGAIN.
Name Email address Cell phone number
Certification
The undersigned individual certifies that he/she is authorized to submit this Permit application on behalf of
the application, that the information furnished above in this application is true and accurate, and that O&I 7-
6-1 (as well as the related regulations of the Airports Authority) are for his/her review, and acknowledges
his/her understanding that the failure to provide in this Permit application all information called for by the
Permit application form will result in the application’s denial.
SIGNED BY THE REPRESENTATIVE (INDIVIDUAL OR FOR THE ORGANIZATION ) DATE OF THE APPLICATION
Signature Date
___________________________
1/
When a proposed Expressive Activity involves the Distribution of Printed Material, a copy of the material to be distributed
during the proposed activity is to be attached to the submitted application. See Section 6.E(1)(h) of O&I 7-6-1.
2/
When a proposed Expressive Activity involves the Sale of Printed Material or Soliciting that is intended to raise funds on
behalf of a charitable, civic or similar organization, documentary evidence that the organization is duly registered (or is
exempt from the requirement it be registered) must be attached to the submitted application. See Section 6.E(1)(g).
3/
Designated Areas are described in Section 6.F of O&I 7-6-1 and are shown in Attachments A and B to the O&I.
4/
Applicants seeking Permits for multiple dates need to submit a separate application for each date.
5/
See Sections 6.E(1)(d) and 6.E(5) of O&I 7-6-1.
6/
See Section 6.E(1)(a) of O&I 7-6-1.
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