**(NPS Form 10-931) (OMB No. 1024-0026)**

**(NEW 10/00) (Expires 12/31/2006)**

**NATIONAL PARK SERVICE**

**Chickasaw National Recreation Area**

**Sulphur, Oklahoma**

**Application for Photography/Filming Permit**

Please supply the information requested below. This information is
required to evaluate your permit request. **Attach additional sheets, if
necessary.** Allow at least four (4) business days for processing. A
non-refundable processing fee may be required to accompany this
application. There may be additional fees charged, including a location
fee, and you may be required to provide proof of liability insurance.

  ----------------------------------- -----------------------------------
  Applicant:                          Company:

  Social Security \#                  Tax ID#:

  Street/Address                      Street Address

  City/State/Zip Code:                City/State/Zip Code:

  Telephone #:                        Telephone #:

  Cell phone #:                       Cell phone #:

  Fax #:                              Fax #:

  Email:                              Email:
  ----------------------------------- -----------------------------------

  ----------------------------------- -----------------------------------
  Project name:                       Producer:

  Type of Project:                    Photographer:

  Location manager:                   Director:

  Telephone #:                        Caterer:

  Cell phone #:                       Telephone \# - set:
  ----------------------------------- -----------------------------------

**Summary of Activities and Scene(s):**

**SCHEDULE BY LOCATION(S)** (Includes filming, parking and base camp):

+------+------------------+-------+-------+-----------------+--------+
| Date | Location         | Start | End   | # Ty            | # Num  |
|      |                  | Time  | Time  | pe of Activity  | ber of |
|      |                  |       |       |                 |  Cast  |
|      |                  |       |       | (e.g., film,    | & Crew |
|      |                  |       |       | prep, or        |        |
|      |                  |       |       | strike)         |        |
+------+------------------+-------+-------+-----------------+--------+
|      |                  |       |       |                 |        |
+------+------------------+-------+-------+-----------------+--------+
|      |                  |       |       |                 |        |
+------+------------------+-------+-------+-----------------+--------+
|      |                  |       |       |                 |        |
+------+------------------+-------+-------+-----------------+--------+
|      |                  |       |       |                 |        |
+------+------------------+-------+-------+-----------------+--------+

Maximum Number of
Participants\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(please
provide best estimate)

Description of Equipment/Props:

Use of Roads and/or Trails? (Y/N): Describe:

I hereby state that the above information given is complete and correct
and that no false or misleading information or false statements have
been given. All estimates are reliable to the best of my knowledge and I
have the full authority to represent the applicant entity and the
project described above.

Signature: Print Name: Date:

Title: Company Name:

Information provided will be used to determine whether a permit will be
issued. Completed application must be accompanied by an application fee
in the form of a cashiers check or money order in the amount of \$
[30]{.underline}.00 made payable to **[National Park
Service]{.underline}**. Application and administrative charges are
non-refundable.

Chickasaw National Recreation Area

1008 W. 2^nd^ Street

Sulphur, OK 73086

580/622-3161

580/622-2296 (fax)

**NOTE** that this is an application only, and does not serve as
permission to conduct a filming project or any other use of a National
Park. If your request is approved, a permit containing applicable
conditions and regulations will be sent to the person designated on the
application. The permit must be signed and returned to the park prior to
the event.

**Paperwork Reduction Act Statement:** This information is being
collected to allow the park manager to make a value judgment on whether
or not to allow the requested use. All the applicable parts of the form
must be completed. A Federal agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless
it displays a currently valid OMB control number

**Estimated Burden Statement:** Public reporting burden for this form is
estimated to average 30 minutes per response including the time it takes
to read, gather and maintain data, review instructions and complete the
form. Direct comments regarding this burden estimate or any aspects of
this form to the National Park Service Program Manager, 1849 C Street,
NW (2460), Washington, D.C. 20240.