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Nps Form 10-931 - Application For Special Use Permit Commercial Filming/still Photography Page 2

Description of equipment, backdrops, sets, props (attach additional pages if necessary). Please note if any of

the following will be included: weapons, animals, minors, nudity):

Number of Vehicles:

Car, SUV or light truck _________

Vehicles greater than a 10,000 lbs. (class 3 or higher) ___________

Have you physically visited the requested area?

Do you plan on advertising or issuing a press release for this activity?

When answering yes to any of the following questions, provide additional information:

Do you have, or are you applying for, a permit with another Federal, State or local

agency for this activity?

Have you had previous permits from the National Park Service?

Have you ever been denied a permit or had a permit revoked by a Federal agency?

Have you forfeited a bond or other security for filming on Federal lands?

Are there any pending Federal investigations against you which

involved a commercial filming activity?

Do you anticipate any security concerns? If yes, explain.

CONTACTS:

Person on location responsible for adherence to all terms & conditions of the permit:

Name: ________________________________ Title: _______________________

Phone: ____________ Cell Phone: ____________

The applicant by his or her signature certifies that all the information given is complete and correct, and that no

false or misleading information or false statements have been given.

Signature: ____________________ Print Name: ______________________ Date: ___________

Title: __________________________ Company Name: ____________________________

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Note: this is an application only, and does not serve as permission to conduct any special activity in the park.

The information provided will be used to determine whether a permit will be issued. Send the completed

application along with the application fee in the form of a credit card, cashier’s check, money order or personal

check made payable to National Park Service at the Park address found on the first page of this application.

If your request is approved, a permit containing applicable terms and conditions will be sent to you. The permit

must be signed by the responsible person and returned to the park for final approval by the Park

Superintendent before the permitted activity may begin.

NPS Form 10-931 rev 06/2013

OMB Control No. 1024-0026

Expires 08-31-2016

Nps Form 10-931 - Application For Special Use Permit Commercial Filming/still Photography Page 2