Business Services Division Special Programs Unit
PO Box 29622 Raleigh, NC 27626-0622
(10/28/2016) Form CG-02
Pursuant to Section 66-237 of the North Carolina General Statutes, the undersigned
submits the following information for the purpose of registering as a salesperson of a
membership camping operator:
Type of Registration: Check the type of Registration below.
Name of Applicant
First Name: _____________________ Last Name: _______________ Suffix: ________
Principal Business Address:
Street or PO Box: ____________________________ City: _____________ State: _____
Zip Code: _______________ Telephone Number: ______________________________
Mailing Address (if different from principal business address shown above:
Street or PO Box: ____________________________ City: _____________ State: _____
Zip Code: _______________
List each membership camping operator for whom you act as a salesperson. Name and
address. If you need additional space, attach on a separate sheet.
Please answer the following:
1. Within the past five years from the date of this application, have you been convicted of
any misdemeanor or felony involving theft, fraud, dishonesty, or moral turpitude, or
been enjoined from, had any civil penalty assessed for, or been found to have engaged
in any violation of any law designed to protect consumers?
Yes No
If answer is “Yes”, attach a summary of dates and details of each event.
North Carolina Department of the Secretary of State
Application for Registration of Membership Camping
Salesperson
