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2. Full Name:*
4. Mailing Address:*
6. Cell Phone:*
7. Work Phone:
9. Email:*
11. Emergency Contact:
12. Emergency Contact Phone Number:
14. Commercial Fishing License Number:*
15. Status:*

    1. Full-time

    1. Part-time
17. Name of Boat:
18. N.C. Registration Number:*
20. Boat Make*
21. Boat Length*
22. Boat Width:*
24. List all commercial fishing activities
26. Harbor Requested:*

    1. Atlantic Harbor
    2. Harkers Island
28. Attach Supporting Documentation*

    Photo of Boat

29. Attach Supporting Documentation*

    Copy of Commercial Fishing License with Endorsements

31. Affirmation:*

    1. Under the penalties prescribed by law, I hereby affirm to the best of my knowledge and belief that all information submitted on this form and accompanying statements is true and complete.
33. First Name*
34. Last Name*
36. Date*
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field