Date:
First Name   Last Name   Address
City   State   Zip
Daytime Phone   Evening Phone   Fax
Email Address   Name as you would like it to appear on your name tag

License Information IF YOU WERE BORN AFTER DECEMBER 31, 1966, A COPY OF A CERTIFICATE SHOWING
COMPLETION OF A HUNTER'S SAFETY COURSE MUST BE INCLUDED WITH YOUR REGISTRATION FORM.

Date of Birth   Social Security#   Height   Weight
Sex Eye Color    Hair Color

List any medical conditions we should be aware of

Room Reservations ALL ROOM RESERVATIONS, INCLUDING RESERVATIONS FOR EXTRA NIGHTS, AND SPECIAL
ROOM REQUESTS ARE HANDLED BY WHITETAIL, LLC, NOT THE INN AT GRAND GLAIZE.

Single    Single with Non-Hunter   Double     Name of hunter you will be rooming with
Smoking   Non-Smoking     List other special room requests

A ROOM FOR FRIDAY, SATURDAY, SUNDAY AND MONDAY NIGHTS IS INCLUDED IN YOUR PACKAGE. If you would like to
reserve a room for additional days at the Inn at Grand Glaize, you will be able to take advantage of a hunter's discount through
Whitetail, LLC. Your reservation must be made through Whitetail, LLC, but the cost of additional days will be payable directly to
the Inn at Grand Glaize at the time of the hunt. (Please check the appropriate boxes below if applicable.)

Tuesday, Nov.8       Wednesday, Nov. 9     Thursday, Nov. 10    Tuesday, Nov. 15
Please list any other additional days

HUNTER'S PACKAGE
Accomodations
**Package Cost
***Deposit Required w/Registration Form
SINGLE OCCUPANCY
      
$2995
                         
$700
DOUBLE OCCUPANCY
      
$2885 EACH
                         
$700 EACH
*Sharing room w/ another hunter
**Refer to Package Information
***Full Deposit is Required
     
NON-HUNTER'S PACKAGE
Four buffet dinners with hunters and all Non-Hunter Programs...$150.00 Non-Hunter package cost must be included with Hunter's deposit and is not refundable after November 1, 2016.
 
Non-Hunter Registration
First Name   Last Name   Address
City   State   Zip
Name as you would like it to appear on your name tag

THE WHITETAIL TROPHY HUNT IS LIMITED TO 230 ENTRANTS.
Deposits are not refundable after September 1, 2016.  (Missouri residents will have $208.00 deducted from the balance due on their entry fee. )


THIS IS A SECURE SITE.  INFORMATION CONTAINED IN THIS FORM IS STRICTLY CONFIDENTIAL!

HUNTER $      NON-HUNTER $     DEPOSIT $    TOTAL $
Visa         MasterCard       Card#   Expiration Date

Hunter acknowledges that hunting can be a dangerous sport. Hunter agrees for himself and his heirs and administrators to release Whitetail, LLC, and Landowners/Guides from any and all claims in the event of any loss, injury, damage or accident or death, occurring in connection with hunting or related activities at or under the sponsorship of Whitetail, LLC. Hunter agrees to practice safety with all weapons at all times and to adhere to safe shooting and hunting practices established by Whitetail, LLC. Whitetail, LLC reserves the right to use all photographs of Hunters and Non-Hunters taken during the event. Hunter acknowledges that he/she has been presented with a copy of the rules and regulations and that he/she agrees to abide by said rules and regulations. Hunter understands and agrees that Hunter deposits are not refundable after
September 1, 2016 and Non-Hunter package costs are not refundable after November 1, 2016Refundable deposits will be reimbursed on or before November 1, 2016. Whitetail Trophy Hunt, L.L.C. reserves the right to refuse registrations from any individuals solely at its discretion.

Portable radios are used to communicate between hunters and hunt headquarters during the Whitetail Trophy Hunt. These radios are provided to to all hunters at no charge, but require a $50 deposit that is collected when the radio is checked out and refunded when the radio is returned. Hunters have the option of using their own radios if they wish. Please check one of the following:

Please provide me with free radio I will provide a deposit at the hunt     I will provide my own radio

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Whitetail Trophy Hunt Registration Form - 2016