1^ST ANNUAL
BROOKFIELD CONSERVATION CLUB
COYOTE HUNT

MARCH 7 - MARCH 13, 2010
REGISTRATION FORM

Registration fee is $10.00. Mail-in applications must be received by Feb. 28,
2010. They must be accompanied with a self-addressed stamped envelope and
registration fee. There will be a sign up day on March 6, 2010 from 11:00am to
4:00pm.

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 #______________________State Issued:______________________

Please read the following statement and verify with your signature.

1 have read the rules and regulations/or the Coyote Hunt as set forth by the
Brookfield Conservation Club and 1 agree to abide by these rules and regulations.

Signature: ______________________________________Date: _________________

******MAIL-INS REMEMBERS TO INCLUDE FEE & SASE******

Mail all forms to: Brookfield Conservation Club
P.O. Box 46

Brookfield, Ohio 44403

__________________________________________________________________________

(Office use only)

Registrant’s #: ____________________                  _____________________

Coyote Reg.#: ____________________                   _____________________

                      ____________________                   _____________________