**(NPS Form 10-930) (OMB No. 1024-0026)**

**(NEW 10/00) National Park Service (Expires 12/31/2006)**

**Catoctin Mountain Park**

**6602 Foxville Road**

**Thurmont, MD 21788-1598**

**Application for Special Use Permit**

> Please supply the information requested below. **Attach additional
> sheets, if necessary, to provide required information**. Allow at
> least two (2) business days for processing. A non-refundable
> processing fee may be required to accompany this application unless
> the requested use is an exercise of a First Amendment right. You will
> be notified of the disposition of the application and the necessary
> steps to secure your final permit. (Note: there may be additional fees
> charged, and you **may** be required to provide proof of liability
> insurance.)

  ----------------------------------- -----------------------------------
  Applicant Name:                     Organization Name:

  Social Security #:                  Tax ID \#

  Street/Address:                     Street/Address:

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

  Telephone #:                        Telephone #:

  Cell phone #:                       Cell phone #:

  Fax #:                              Fax#:

  Description of Proposed Activity    
  (attach diagram):                   

                                      

                                      
  ----------------------------------- -----------------------------------

Requested Location:

Date (s):

+-----------------+-----------------+-----------------+-----------------+
| # Event se      | # E             | Event will end  | Removal will be |
| t up will begin | vent will begin |                 | done:           |
+-----------------+-----------------+-----------------+-----------------+
|                 |                 |                 |                 |
+-----------------+-----------------+-----------------+-----------------+

> Maximum Number of Participants (Please provide best estimate)
>
> Maximum Number of Vehicles (attach parking plan)
>
> Support Equipment (list all equipment)
>
> Support Personnel (contractors, etc. including addresses and
> telephones)
>
> Individual in charge of event on site (include address, telephone and
> cell phone numbers):
>
> Is this an exercise of First Amendment Rights? Y N
>
> Are you familiar with/ have you visited the requested area? Y N
>
> Do you plan to advertise or issue a press release? Y N
>
> Will you distribute printed material? Y N
>
> Is there any reason to believe there will be attempts to disrupt,
>
> protest or prevent your event?(if yes explain on separate sheet) Y N
>
> 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 Date

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 \$50.00
made payable to **[National Park Service]{.underline}**. Application and
administrative charges are non-refundable. *This completed application
should be mailed to Park address information.*

**Note** that this is an application only, and does not serve as
permission to conduct a filming project or any other use of the 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.

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

*The above application form is provided with the understanding that
parks will insert appropriate park names and addresses and the amount of
the application fee as desired.*

**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, Special Park Uses Program
Manager, 1849 C Street NW (2460), Washington, D.C. 20240