Request to scout on State Park Property/Meet with State Park Official

Applicant
Title of Applicant
Title of Production
Production Company
Address
City
State
Zip
Phone
Fax
Email

Location(s) desired
Carolina Beach State Park Cliffs of the Neuse State Park Crowders Mountain State Park Dismal Swamp (NC Jurisdiction) Elk Knob State Natural Area Eno River State Park Falls Lake State Recreation Area Fort Fisher State Recreation Area Fort Macon State Park Goose Creek State Park Gorges State Park Hammocks Beach State Park Hanging Rock State Park Haw River State Park Jockey's Ridge State Park Jones Lake State Park Jordan Lake State Recreation Area Kerr Lake State Recreation Area Lake James State Park	Lake Norman State Park Lake Waccamaw State Park Lumber River State Park Mayo River State Park Medoc Mountain State Park Merchants Millpond State Park Morrow Mountain State Park Mount Jefferson State Natural Area Mount Mitchell State Park New River State Park Occoneechee Mountain State Natural Area Pettigrew State Park Pilot Mountain State Park Raven Rock State Park Singletary Lake State Park South Mountains State Park Stone Mountain State Park Weymouth Woods/Sandhills Nature Preserve William B. Umstead State Park

Type of Project(s)
Feature Film TV/Cable Movie Commercial/Infomercial Still Shoot Documentary/News	Industrial/Educational TV/Series/Episode Music Video Other (describe below)

Production Date
Time Window e.g.(1pm-3pm)	From To

Brief Description of what you'll be filming/scope of activity
I would like to meet with the specified park’s superintendent at his/her earliest convenience to discuss my up-coming project and apply for a State permit. I understand a Special Activity fee of $30.00 must be given to the Park Superintendent at the time of walk-through should my application be accepted, and a permit number will be given to me. A performance bond may also be required, at the discretion of the Division of Parks & Recreation, to ensure protection of natural resources. By submitting this form, you attest that the information provided herein is complete, correct, and in no way misleading or false; that you are the fully-authorized to representative of the production stated and will work with NC state officials to adhere to their safety regulations to protect property and lives.