ROCKY MOUNTAIN VETERANS HUNTS & EXCURSIONS

Name

First Name Last Name

Email

example@example.com

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Area Code Phone Number

SS# (last 4): Age: Date of birth: / / Gender: (circle one) M F Hunter Education Card Number: State of Issue: *Not required if born before January 1, 1949 CPW CID Number:

Emergency Contact Information Name: Relationship: Address: City: State: Zip Code: Telephone Number:(day) (evening)

Service Connection Are you service connected: yes no If so, how much? % What is your service connection?

Medical information Who is your medical physician? Physician emergency contact phone number: Type of medical diagnoses:

Do you have any physical problems (bad back, trouble breathing, etc.)? Mobility: Ambulatory Ambulatory with assistive device (cane, crutches) Wheelchair Special or adaptive equipment: Do you use a CPAP machine? Yes No Comments: Please list any other special needs you may have

Program Interests *You may apply for more than one program. However, you will only be selected for one unless there is availability. If you are applying for more than program indicate which programs you would like to prefer in numerical order. Example: 1 being your top choice, 2 your second, and so on. Elk hunt Bear Deer hunt Lion Antelope Hunt Turkey Preferred hunting method: Archery Muzzleloader Rifle *Type of hunts will depend on what licenses are available from the CPW & from landowner donor. Dates will be setup through the DOW and landowners.

Program Experience Answer the following questions and sign at the bottom of the page (if question does not apply leave blank):1. Have you ever hunted before? Yes No (if yes go to 1a) 1a.Elk Year last hunted Bear Year last hunted Deer Year last hunted Lion Year last hunted Antelope Year last hunted Turkey Year last hunted 2. Do you have any of your own equipment that will be needed for the program you are applying for? 3. Caliber (recommend .270 or larger), mfg., model of the rifle you anticipate using during the hunt and must be scoped. No semi-automatics: * GUNS WILL BE INSPECTED FOR SAFETY 4. Last time you shot the gun you will be using: 5. Comments:

SIGNATURE:

DATE:

Questions/comments regarding applications:
Richard Teague
Selection Committee
970-379-3367
Rocky Mountain Veterans’ Hunts & Excursions Inc.
P.O. Box 1515
Rifle, Colorado 81650
RMVetHunts@gmail.com

Applications for hunting are due no later than June 15th.

** Note: Please attach a copy of DD214.