General Information:

Name

Phone Number

Work Phone Number

Cell Phone Number

Email Address

Street Address

City State Zip

Additional Members in Party 1 2 3 4 5

Member Names

I will be hunting: (check all that apply)
Elk
Deer
Bear
Big Horn Sheep
Mountain Lion
Antelope

Season Dates I will be hunting are:

Check if appropriate:
Rifle 1st
Rifle 2nd
Rifle 3rd
Drop Camp
Guided Camp
High Country Buck Hunt
Archery Deer or Elk
Muzzle-loader Hunt

Deposit is half the hunt price.  I am enclosing    $

*All Deposits are non-refundable but can be transferred during same year.

Health Questions:

Do you have any medical conditions that we need to address?
NO    Yes    (If you answered yes, please specify your medical condition in
     the following box.)

The mountains can be rugged. We use horses to pack you in, but there is
some physical exertion. You will be staying at about 10,000 - 11,500' above
sea level and so your oxygen will be much less than you may be used to.
If you tend to get altitude sickness, you can get a prescription drug called
Diamox if you would like to see your physician. It is recommended to begin
taking it 3 days before arrival.

Are you diabetic?      Yes   No

Do you have a heart conditon?      Yes    No

Do you have a respiratory condition?      Yes    No

Do you have problems with one or both knees? Yes No

Allergies?      Yes      No   (If you answered yes to this question, please list your allergies        
 in the following box)   

Physical limitations or challanges?   Yes No (If you answered yes to this question,
      please list your condition(s) in the following box.)
     

We need to match you with a horse:
Height:          Weight:

Persons to contact in case of emergency:

Name: Relationship:

Address:

Phone Numbers:

Name: Relationship:

Address:

Phone Numbers: