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2021-01-21T20:54:37+00:00
First Name
*
Last Name
*
Street Address
*
Street Address 2
City
*
State/Region
*
Postal/Zip Code
*
Country
*
Phone
Email
Is the hunter active or retired military?
Yes
No
Does the hunter possess any of the following?
State Issued P2A Disability Card (or related materials)
Hunter Education Card (only if born after January 1, 1980)
Firearm Owner Identification (resident hunters) please include number below
State Issued Habitat Stamp (required for all hunters unless under the age of 16)
Fishing License
FOID Card Number
Is the hunter confined to a wheelchair (non-ambulatory)?
Yes
No
Would you anticipate using a motorized or non-motorized wheelchair to get to a blind?
Yes
No
Please describe the exact nature of any disability and/or major health problems:
Submit
If you are human, leave this field blank.
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