21st ANNUAL COYOTE HUNT REGISTRATION

FRI. FEB. 17, SAT. FEB. 18, SUN. FEB. 19, 2012

 (Office use only)

Coyote Reg. # _______________

2012 Member # ______________
Registration Fee - $10.00. Registrant must be member of Mosquito Creek Sportsmen's Association. Membership Application may accompany registration. Mail-in applications MUST be received by January 31, 2012 & MUST include Registration Fee & Self-Addressed, Stamped Envelope (SASE).

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

First Name___________________________

Last Name___________________________

Phone # (____) _________-_____________

Mailing Address________________________________________________________________

City__________________________________ State_____________ Zip______________

  __ $2.00 ENTRANCE FEE FOR FEMALE COYOTE

Please read the following statement and verify with your signature: I have read the rules & regulations for the Coyote Hunt as set fourth by the Mosquito Creek Sportsman's Assoc., and agree to abide by these rules and regulations.

Signature:______________________________________________ Date:______________

*** Mail-ins - Remember to include Fee & SASE