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Form 10-932 - Application For Special Use Permit Commercial Filming/still Photography - National Park Of American Samoa Page 3

Portable crane___ Car mount ___ Camera car, shot maker, or process trailer ___

OPERATIONAL INFORMATION:

Vehicles:

Number of Cars, SUVs or light pick-up trucks ____________

Number of Vehicles greater than a 10,000 lbs. (class 3 or higher)__________________

NOTE: Large or oversized vehicles may not be able to be accommodated or additional steps may need to be

taken to ensure that no damage to park resource occurs.

BASE CAMP LOCATION: (attach diagram): ____________________________________________

SPECIAL ACTIVITIES

INVOLVEMENT OF MINORS:

Children: o None

o Yes

# of Children

Age Range ______________________

LIVESTOCK and/or TRAINED ANIMALS:

Number and type of animal: _______________ Manner of transportation: _____________________

Staging/corralling needs (attach plan if necessary):_______________________________________

AIRCRAFT: o No o Yes (explain)

NOTE: All aircraft use over park lands should be listed. Landings must be specifically requested and approved as

a condition of your permit.

SPECIAL EFFECTS (including weapons, pyrotechnics, etc):

o No o Yes (identify)

Effects Technician Name:

Phone # ____________________________

License # (if applicable)

Permit # (if applicable) ________________

STUNTS: o No o Yes (explain)

Coordinator _______________________Phone #________________ Email_____________________

Any other unusual or hazardous activities? o No o Yes (explain)

NPS Form 10-932 rev 06/2013

OMB Control No. 1024-0026

Expires 08/31/2016

Form 10-932 - Application For Special Use Permit Commercial Filming/still Photography - National Park Of American Samoa Page 3