BEFORE YOU START - MAKE SURE THIS APPLICATION CAN BE TURNED IN 180 DAYS PRIOR TO THE EVENT OR ACTIVITY (More or less time may be needed to complete work on your permit. Contact the appropriate BLM District Office for additional information.)

Page One

DO NOT ENTER THE PERMIT NUMBER. The authorized official will assign a permit number.

1. Enter your name or the name of your organization, including the department.
2. Enter your address or the address of your organization.
3. Enter your business telephone number and your residence telephone number.
4. Enter the name of the Public Land that you would like to use for your event or activity and attach a map of the area. The map should indicate the track or course, concession-stand areas, registration area, first-aid areas, and any other areas associated with your event or activity.
5. Describe the purpose of the event or activity. State the projected number of participants and spectators.
6. Fill in the arrival date and time and the departure date and time.
7. Check the type of permit you are requesting.
8. Describe all facilities that you will be providing, such as porto-potties, concession stands, first-aid stations, and others. Be sure to include all of these facilities on the map.
9. If you have been issued a permit for a previous event, fill in the name of the BLM District Office that issued the permit and the date of the permit. Check whether you or your organization forfeited any portion of the permit, bond, or surety, or if any investigation or legal action is pending against you or your organization for use of Public Land. If you checked yes, describe the issue in detail on a separate piece of paper and attach it to the application.
10. Sign the application. If you are filling out the application on-line, print two copies and sign each copy. Send one original to the appropriate BLM District Office and keep the other original for your records. You will not be able to save the information that you entered.

Page Two

DO NOT CHECK ANY OF THE BOXES ON THIS PAGE. The authorized official will check the appropriate boxes.

Send in your application

Send your completed and signed application to the appropriate BLM District Office. Detach page three, the Post-Use Report, for filing after the event is completed.

Contact the appropriate BLM District Office regarding completion of the following information

1. A map of the area, the course or track, and all facilities that you will be providing.
2. An operation plan.
3. A description of events if you or your organization have, with any previous permits, forfeited any portion of the permit, bond, or surety or if any investigation or legal action is pending against you for use of public lands.
4. Proof of private landowner or other agency permission.
5. Proof of insurance.
6. A copy of your license.
7. Any additional District Office forms.

Page Three/ Post-Use Report

1. Send this report to the appropriate BLM District Office within 30 days of the completion of your event or activity.
2. Enter the number of participants, spectators, and employees that attended the event.
3. Enter the fees charged to each participant and each spectator.
4. Enter the gross profit, and include all receipts.
5. Describe any problems that occurred at the event, such as crowd control, hazards, and accidents.
6. Write your name, address, and telephone number(s) (both business and residence). Sign the report and send it to the appropriate BLM District Office.