NRC FORM 590

(10-02-2023)

APPLICATION/PERMIT FOR USE OF THE TWO WHITE FLINT 

NORTH (TWFN) AUDITORIUM

U.S. NUCLEAR REGULATORY COMMISSION

Because fewer than ten respondents submit this form annually, this form is not a collection of information as defined by the Paperwork Reduction Act of 

1995 and 5 CFR Part 1320.3(c). No Office of Management and Budget clearance is required.

INSTRUCTIONS: Please submit with this application a copy, sample, or description of any material or item(s) proposed for distribution or display. Complete 

the check list of service needs for public-use space on the reverse of this form. Failure to complete this form will result in denial of a permit. 

IMPORTANT: If the applicant proposes to represent an organization, a letter or other documentation that the applicant has authority to represent that 

organization must be submitted with this form.

1. Proposed 

 Date(s)

From (MM/DD/YYYY) Hour AM or PM To (MM/DD/YYYY) Hour AM or PM

2. Name of Applicant (First, Middle Initial, Last) Telephone Number

Business Address (Street, Suite/Apt. No., City, State and Zip Code)

3. Name of Person or Organization Sponsoring, Promoting, or Conducting the Proposed Activity Telephone Number

Business Address (Street, Suite/Apt. No., City, State and Zip Code)

4. Name of Person(s) Who Will Supervise/Be Responsible for the Proposed Activity Telephone Number

Business Address (Street, Suite/Apt. No., City, State and Zip Code)

5. Description of Proposed Activity

6. Certification

AN APPLICANT PROPOSING TO ENGAGE IN THE SOLICITATION OF FUNDS MUST CHECK ONE OF THE FOLLOWING STATEMENTS:

I CERTIFY THAT:

I represent and will be soliciting funds for the sole benefit of a religion or religious group.

My organization has received an official Internal Revenue Service (IRS) ruling or letter of determination stating that the organization or its parent organization 

qualifies for tax-exempt status under 26 U.S.C. 501(c)(3),(c)(4), or (c)(5).

My organization has applied to the IRS for a determination of tax-exempt status under 26 U.S.C. 501(c)(3),(c)(4), or (c)(5) and that the IRS has not yet issued a final 

administrative ruling or determination of such status.

I certify that I am authorized to sign this application on behalf of the named organization. I have read and fully comprehend all fees, rules, and regulations contained 

in the policies and procedures associated with the use of the Two White Flint North Auditorium. I fully accept liability for any damages that may occur during the 

scheduled use or any additional charges that may result from the designated use of the auditorium.

 Signature and Date - Applicant

NRC FORM 590 (10-02-2023) Page 1 of 2

Email Address

Email Address

Email Address
NRC FORM 590

(10-02-2023)

U.S. NUCLEAR REGULATORY COMMISSION

APPLICATION/PERMIT FOR USE OF THE TWO WHITE FLINT NORTH (TWFN) 

AUDITORIUM (Continued)

CHECK LIST OF SERVICE NEEDS FOR PUBLIC-USE SPACE

AUDITORIUM (Check items needed)

MICROPHONE

PODIUM

DAIS CONFIGURATION

CATERING KITCHEN

Will Food or Drink be Served During Program Hours? YES NO

It is the user's responsibility to ensure that the kitchen is 

clean and in order before leaving the premises.

NRC USE ONLY

SCHEDULE OF COSTS FOR AUDITORIUM USE. All programs are after NRC normal hours of operation.

Services Per Hour Cost Per Hour Total Cost Event Date 

(MM/DD/YYY)

Start Time

End Time

Number of 

Event Hours

Auditorium Only $81.50 / per hour

Audiovisual Photography $102.00 / per hour

Custodial Support Services 

(Mandatory flat rate) $302.00 / flat rate

TOTAL

ADMINISTRATIVE REVIEW

APPROVED DISAPPROVED

If Disapproved, Reason for Disapproval

Reviewing Official (Typed Name and Title)

Signature and Date - Reviewing Official - Administration

SECURITY REVIEW

APPROVED DISAPPROVED

Reviewing Official (Typed Name and Title)

Signature and Date - Reviewing Official - Security

PERMIT FOR USE OF THE TWO WHITE FLINT NORTH AUDITORIUM

BASED UPON ADMINISTRATIVE AND SECURITY REVIEWS, THIS APPLICATION IS: APPROVED DISAPPROVED

Reviewing Official (Typed Name and Title)

Signature and Date - Reviewing Official - Final Approval

NRC FORM 590 (10-02-2023) Page 2 of 2