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TITLE:
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Mrs.
Ms.
Dr.
Other
FIRST NAME(S):
SURNAME:
ADDRESS:
TOWN / CITY:
STATE / REGION:
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COUNTRY:
TELEPHONE NUMBER:
(PLEASE INCLUDE AREA CODE)
FAX NUMBER:
EMAIL ADDRESS:
PERSON TO CONTACT IN CASE OF EMERGENCY:
FULL NAME:
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FAX NUMBER:
EMAIL ADDRESS:
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YEAR
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2009
2010
2011
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DON'T KNOW:
# OF HUNTERS:
# OF NON-HUNTERS:
# OF CHILDREN:
SPECIES WANTED:
ARE YOU A RIFLE HUNTER ?
YES
NO
ARE YOU A BOW HUNTER ?
YES
NO
IF BOW HUNTER PLEASE SPECIFY :
TRADITIONAL
COMPOUND
BOTH
WILL YOU BRING YOUR OWN BOW OR FIREARM?:
YES:
NO:
WILL YOU BE DOING A
PHOTOGRAPHIC SAFARI
BEFORE OR AFTER THE HUNT?
YES:
NO:
IF SO PLEASE SPECIFY:
PLEASE TELL US YOUR FOOD & BEVERAGE PREFERENCES:
FOOD LIKES:
FOOD DISLIKES:
FOOD ALLERGIES:
WINE:
BEER:
SPIRITS:
JUICES AND SOFT DRINKS:
DO YOU REQUIRE A LOW-SALT, DIABETIC OR ANY OTHER SPECIAL DIET?:
YES:
NO:
IF SO PLEASE SPECIFY:
PLEASE TELL US ABOUT YOUR HEALTH
DO YOU HAVE A SPECIAL MEDICAL CONDITION?
ARE YOU TAKING ANY SPECIAL MEDICATION?
ARE YOU ALLERGIC TO INSECTS / ANTIBIOTICS ETC?
WHAT IS YOUR BLOOD TYPE?
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