HUNTER REGISTRATION

First Name _____________ Middle _______________ Last ______________________

Address_________________________________________________________________

City________________________________________State_________Zip____________

Telephone- Home___________________________Business_______________________

E-mail__________________________________________________________________

Drivers License # ____________________________ Social Security # ______________

Eye Color ______ Weight ________ Height _______ Date of Birth ________

Circle: Rifle Archery Muzzleloader Handgun Right or left handed shooter

Hunt Date Options: A) Sept. 1^st -5^th B) Sept. 6^th -10^th C) Sept. 11^th -15^th D) Sept. 16^th -20^th

1^st Choice _________ 2^nd Choice _________ 3^rd Choice ________

Down Payment: $1,000.00. Refundable if not successful in drawing a tag.

Balance due_______________________

Payment: Check / Visa / MC #_______-_______-________-_______Exp___________

Signature________________________________________________________________