Filming Request Form

Please complete the form below with as much detail as possible.

Date of Application

Contact Information

Email Address *

Primary Phone Number *

Name of Organization/College/Production Company

Location Description

Has permission already been granted to film by business or home owner?

Yes

Please provide name, email and/or phone information for property owner

Project title

Requested film shoot start date

Requested film shoot end date

Scene Description

How many actors and production members will be on site for production?

Will you require use of police officers or other City staff for crowd/traffic control, electricity or other services? If yes, please explain

Are you requesting any special parking permissions for this location? If so, please describe:

Have you made separate parking, storage or security arrangements with any private company or individual? If so, please describe arrangement including name of contractor:

Is your project in Lynchburg a result of a referral from the Virginia Film Office?

Yes

I/We certify that all the information in this application, or attached to it, is complete, true and accurate, and that any misrepresentation will be cause for revocation of any permit granted, and the I/We will promptly amend/supplement the information.

By signing this form, you acknoledge that you have read all requirements and guidelines associated with this form for filming in the City of Lynchburg, Virginia.

With your signature you agree to indemnify, hold harmless, and defend the City of Lynchburg, Virginia, its employees and officials, from all claims and lawsuits arising out of your or your film crew's filming activities.

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Thank you! Someone from the Office of Economic Development & Toursim will be in touch with you within ten working days.