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Triangle Outfitters
P.O.Box 72
Nashport, OH 43830
740-345-4986 or 740-763-3401

NOTE: This Hunter Information Form must be printed, signed & returned to us prior to your hunt.


Hunter Information Form

Dates you will be hunting: From: _________/____/_____ To: _________/____/_____

Name: __________________________________________________________________

Home Address: __________________________________________________________

City: ________________________________________ State: _______ ZIP: __________

Phone: (_______)_____________________ Fax: (________)______________________

Work Address: ___________________________________________________________

City: ________________________________________ State: _______ ZIP: __________

Phone: (_______)_____________________ Fax: (________)______________________

Date of Birth (Month/Day/Year): ________/________/________

Driver's License Number: ________________________________ State: ___________

Social Security Number: ___________-_________-___________

Occupation: _____________________________________________________________

General Health Conditions: ______ Excellent ______ Good ______ Fair _____ Poor

Allergies (Foods, Bee Stings, Plants, etc.): ___________________________________

_________________________________________________________________________

Do you have any limitations or disabilities? _________________________________

_________________________________________________________________________

Do you have any special dietary needs? (Information only necessary for hunters

contracting for room and board) ____________________________________________

_________________________________________________________________________

In Case of an Emergency, Contact:

Name: ________________________________________ Phone: (_____)_____________






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