Donating Company : |
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Company Membership #: |
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Outfitter's First & Last Name : |
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Full Address(include City, State/Province, Postal Code): |
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Country: |
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Email: |
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Website: |
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Phone: |
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Fax: |
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Fair Market Value: |
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Please Select Donation Level: |
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TIN # or SS#(required to receive rebate) |
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Please Check One: |
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Number of Hunters/Anglers: |
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Number of Non-Hunters or Guests: |
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Cost for Extra Hunters or Anglers: |
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Cost for Non-Hunters or Non-Anglers: |
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Game or Fish Sought: |
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Is Field Prep Included(i.e. Caping, Skinning, Salting): |
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Free Ranging: |
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If No, Type of Enclosure: |
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Method(s) of Take: |
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Number of Guides: |
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Location of Hunt(specific hunt/fish area): |
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Game that can be Added: |
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Trophy Fees Included: |
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Trophy Fees Not Included: |
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Actual Hunt/Fish Days Included: |
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Can Trip be Extended: |
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Cost Per Day: |
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Range of Dates Trip can be Scheduled: |
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Can this Trip be taken in Alternate Years: |
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Years:
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Are Special Transportation Charges Required? |
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Type of Transportation: |
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Estimated Cost: |
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Above Cost Included? |
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Trip Arrival & Departure Point: |
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Type of Accommodations Included: |
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Fees Not Included in Donation: |
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Total Cost of License/Permit Fees: |
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Total Cost of Tag Fees: |
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Are any CITES Permits Required? |
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CITES Cost Included? |
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Is Permit by Drawing or Lottery? |
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If Yes, Application Deadline: |
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Is Firearm Permit Required? |
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Provided? |
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List Other Amenities Included: |
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What Other Fees Incurred by Hunter/Angler? |
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Dipping, Packing, Expediting or Other Charges? |
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Any Other Government Fees or GST? |
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Cost:
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Do You Want a Booth at Fundraiser? |
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Special Needs for Booth, if any? (electricity, etc.) |
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Comments: |
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Before submitting this form, please ensure that all fields have been completed.
Please email photos, brochures, a copy of your full price list and the verbiage you'd like us to use to promote your hunt in our event program.
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