2^nd ANNUAL

BROOKFIELD CONSERVATION CLUB COYOTE HUNT

FEBRUARY 6^th THRU FEBRUARY 12, 2011

REGISTRATION FORM

Registration fee is $10.00 Mail in applications must be received by February 6^th 2011.  They must be accompanied with a self addressed stamped envelope and the $10.00 registration fee.  There will be a sign up day February 6^th 2010 from 11:00 AM to 4:00 PM.

Fill in all information.  Applications that are incomplete or illegible will not be processed.

First Name:  ___________________________________________________

Last Name:  ___________________________________________________

Mailing Address: _______________________________________________

City: _______________________ State:  __________ Zip:   ____________

Phone:  (_____)_________________

Hunting License Number:  ________________________________________

Please read the following statement and verify with your signature.

I have read the rules and regulations for the Coyote Hunt as set forth by the Brookfield Conservation Club and agree to abide by these rules and regulations.

Signature:  ______________________________________  Date:  ____________

****  MAIL-INS REMEMBER, INCLUDE FEE AND SASE ****

Mail all forms to:  Brookfield Conservation Club

                                P O Box 46

Office use only

Registration #:  ________________

Coyote Reg:  # ________________     ________________      ________________

                         ________________     ________________      ________________

                         ________________     ________________      ________________