Info Form Personal InformationName* First Last Group Leader* Phone*Email* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Drivers License* Last 4 Digits of SSN*Date of Birth* MM slash DD slash YYYY Emergency Contact* Emergency Phone*TravelDo you needt o be picked up from Mitchell Airport?* Yes No If driving to the lodge, what is your approximate arrival time? What is your arrival date? MM slash DD slash YYYY What is your flight arrival time? : Hours Minutes AM PM AM/PM What is your flight departure date? MM slash DD slash YYYY What is your flight departure time? : Hours Minutes AM PM AM/PM Additional InformationDo you have any special diatery needs? Yes No If you have any special dietary needs, what are they? Do you have any physical needs or concerns? Yes No If you have any physical needs or concerns, what are they? Do you need to rent a gun? Yes No Any other general comments?