Name: _______________________________________________________________________________________________________

                      First                                          Middle Initial                          Last

Street address:__________________________________________ City:______________________ State:______ Zip:_____________

Home phone (_____)_____-_______ Cell (_____)_____-_______ Work phone (_____)_____-________ Fax (_____)_____-________

Email ____________________________________  Gender: ____ Birth Date___/___/___  Age:_____  Height: ______ Weight: ______

Hair Color:___________ Eye color:_________  Physical shape: ____________________   Hunters safety #: _____________________

Health Concerns: [ ] Heart   [ ] Allergies   [ ] Diabetes   [ ] Hiking difficulty  [ ] Color/night blindness   [ ] Other____________________

Exercise schedule: ________________________________________________________________________  Are you a smoker? _____

Person to contact in emergency: ________________________________ Relationship: ______________ Phone: (____)____-_______

Hunting trips you intend to take in the next few years:

Trip 1:  Species: _____________________ Location: _______________ Goals on hunt: ______________________________________

Price range: _______________________________  Other requirements: __________________________________________________

Trip 2:  Species: _____________________ Location: _______________ Goals on hunt: ______________________________________

Price range: _______________________________  Other requirements: __________________________________________________

Trip 3:  Species: _____________________ Location: _______________ Goals on hunt: ______________________________________

Price range: _______________________________  Other requirements: __________________________________________________

Best outfitters you’ve used: ______________________________________________________________________________________

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Worst outfitters you’ve used: _____________________________________________________________________________________

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Your big game hunting experience (places, species, sizes – use other side if needed): ________________________________________

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