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DuPont State Recreational Forest Commercial Use Permit Application
Company or Organization Name: ___________________________________________________
Address: ________________________________________________________________________
Key person contact: ____________________________ Title: ___________________________
Phone: ______________ Fax: ____________ E-Mail: ___________________________________
Describe the activity or event and the location you wish to have permitted:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Access Areas to be Used (check all that apply):
___ Corn Mill Shoals, ___Fawn Lake, ___ Guion Farm, ___ High Falls, ___ Hooker Falls, ___ Lake Imaging
What is the timeframe for the activity or event?
Requested date(s): ___________________________ Starting time: _____ Ending time: _____
For continuing activities: Starting date __________ Ending date __________
What is the estimated number of participants including staff?
Users Number Total
Per Group of Groups Participants
On foot _____ _____ _____
On bikes _____ _____ _____
On horseback _____ _____ _____
In vehicles _____ _____ _____
Other _____ _____ _____
Liability Insurance (Company Name)
: __________________________________________________
Attach a copy of Certificate of Liability Insurance.
Medical Plan: Attach a copy of the event medical plan, if required.
Mail completed application to:
Or E-Mail to:
DuPont State Recreational Forest dupontsf.ncfs@ncagr.gov
PO Box 300
Cedar Mountain, NC 28718 If you have questions call 828-877-6527
