Nps Form - Application Requirements For A Commercial Filming/still Photography Permit - United States Department Of The Interior Page 2

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National Park Service
Mojave National Preserve
2701 Barstow Road, Barstow, CA 92311
(760) 252-6107
Application for Special Use Permit
Commercial Filming/Still Photography
Please supply the information requested below. Attach additional sheets, if necessary, to provide
required information. A nonrefundable processing fee of $111.00 must accompany this application unless
the requested use is an exercise of a First Amendment right. You must allow sufficient time for the park to
process your request; check with the park for guidelines. You will be notified of the status of the application
and the necessary steps to secure your final permit. Your permit may require the payment of cost recovery
charges and proof of liability insurance naming the United States of America as also insured.
Enter either a social security number OR a tax ID number: we do not require both.
Applicant Name:
Applicant Company:
Social Security #:
Tax ID #:
Street/Address:
Street/Address:
City/State/Zip Code:
City/State/Zip Code:
Telephone #:
Contact name:
Cell phone #:
Telephone #:
Fax #:
Fax #:
Email:
Email:
Project name:
Telephone #:
Location manager
Cell phone #:
E-mail:
S till photogra phy
vide o/m otion picture /film
TYPE OF PROJECT:
Detailed description of onsite activities (attach additional pages as necessary):
LOCATION SCHEDULE
Each date and each location must have an individual entry – use additional pages as necessary.
Date
Location
Start Time End
Interior/
Activity: Set-Up/
# of Cast &
Time
Film / Non-
Crew*
Exterior
Filming
/Breakdown
* number in this column should include all individuals present at the location
NPS Form 10-931 rev 06/2013
OMB Control No. 1024-0026
Expires 08-31-2016

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