Division of Parks and Recreation Request to Scout on State Park Property, Meet with State Park Official for Film, Photography Project Date: North Carolina State Park desired for shoot: Carolina Beach State Park State Park Cliffs of the Neuse State Park State Park Crowders Mountain State Park (N.C. Jurisdiction) Medoc Mountain State Park Merchants Millpond State Park Morrow Mountain State Park Falls Lake State Recreation Area Mount Jefferson State Natural Area State Recreation Area Mount Mitchell State Park Occoneechee Mountain State Natural Area State Park Pilot Mountain State Park Hammocks Beach State Park State Park South Mountains State Park Jockey’s Ridge State Park Stone Mountain State Park Weymouth Woods Sandhills State Nature Preserve Jordan Lake State Recreation Area William B. Umstead State Park Kerr Lake State Recreation Area Other: ______

Type of project you’re scouting for: Feature film TV/cable movie Industrial educational Commercial/infommercial Still shoot Documentary/News TV/cable series/episode Music video Other: ______

Proposed time window of shoot: From ______To ______Brief description of what you’ll be shooting/scope of activity: ______

I would like to meet with the specified park’s superintendent at his/her earliest convenience to discuss my upcoming project and apply for a permit. I understand a Special Activity fee 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 my also be required, at the discretion of the Division, to ensure protection of natural resources.

Name: ______Company: ______Phone: ______Fax: ______Email: ______Address: ______City: ______State: ______Zip: ______