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Contact Us

Fill out our simple registration form to book your hunt.

Name
Address
City
State
Zip Code
Day Time Phone
Evening Phone
Work Phone
Work Hours
Date of Birth
Country of Origin
Blood Type
Dental Records on File	yesno
Drivers License Number
Number of dogs or dangerous animals in household
Home Security Access Code (if applicable)

Macke and Model of Vehicle(s) registered to Hunter

Make Model
Make Model
Make Model
Make Model
Make Model

Type of Hunt

Deer	Bear
Fowl	Black
Pheasant	Brown
Grouse	Grizzly
Cracker Jack	Polar
Salmon	Group
Other

Type of Weapon
Rifle	Shotgun
Archery	Pistol
Knife	Sharp Stick

List 3 Potential Date Requests MM/DD/YY
Month Day Year
Month Day Year
Month Day Year

General Background Information
(if applicable)

Name of Spouse
Work Phone Work Hours

List Dependent Children Names and School Hours

Credit Card Information

A $746.39 non-refundable deposit must accompany application.

Name of Card	Card
Card Number	Expiration Date

List Bank accounts and Account Numbers

Attorney (if applicable) holding
will/living trust/assets in hunter�s name
Name Phone

Please allow 6-8 months for confirmation of your order

Cap'n Jim Adamski PO Box 666 Toledo, OH. 48614