Western Native Trout Challenge Verification Form v2.0

Western Native Trout Challenge Verification Form

For more information about the Challenge, including rules and detailed information on species in each state, please review the Western Native Trout Challenge maps at www.westernnativetroutchallenge.org
First Name (type your name as you would like it to appear on your certificate)*
Middle Name (optional)
Last Name*
Street Address*
City*
State*
ZipCode*
Phone Number*

Area CodePhone Number
Email*
example@example.com
To qualify for the Expert Caster: Catch and photograph 6 species across at least 4 states

To qualify for the Advanced Caster: Catch and photograph 12 species across at least 8 states

To qualify for the Master Caster: Catch and photograph 18 species across all 12 states
Indicate the Challenge Level for which you are applying.*

Expert CasterAdvanced CasterMaster Caster
If you are qualifying for Expert Caster, please provide the information for 6 species below. If you are qualifying for Advanced Caster, please provide the information for 12 species below. If you are qualifying for Master Caster, please provide the information for 18 species below. For label all photos with the species name, date, and location caught. You may upload one photo for each trout species, or you may upload one file (e.g., .pdf or Word document, e.g.) that includes all photos. If you upload one file, simply upload it as an attachment with the first trout species (below).
Trout Species #1*
Trout Species #1 - Date Caught*

MonthDayYear
Date
Trout Species #1 - State Caught*
Trout Species #1 - Water Body Caught*
Trout Species #1 - Gear Type*
Trout Species #1 - Trout Released?*
Trout Species #1 - Photo

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Trout Species #2*
Trout Species #2 - Date Caught*

MonthDayYear
Date
Trout Species #2 - State Caught*
Trout Species #2 - Water Body Caught*
Trout Species #2 - Gear Type*
Trout Species #2 - Trout Released?*
Trout Species #2 - Photo

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Trout Species #3*
Trout Species #3 - Date Caught*

MonthDayYear
Date
Trout Species #3 - State Caught*
Trout Species #3 - Water Body Caught*
Trout Species #3 - Gear Type*
Trout Species #3 - Trout Released?*
Trout Species #3 - Photo

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Trout Species #4*
Trout Species #4 - Date Caught*

MonthDayYear
Date
Trout Species #4 - State Caught*
Trout Species #4 - Water Body Caught*
Trout Species #4 - Gear Type*
Trout Species #4 - Trout Released?*
Trout Species #4 - Photo

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Trout Species #5*
Trout Species #5 - Date Caught*

MonthDayYear
Date
Trout Species #5 - State Caught*
Trout Species #5 - Water Body Caught*
Trout Species #5 - Gear Type*
Trout Species #5 - Trout Released?*
Trout Species #5 - Photo

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Trout Species #6*
Trout Species #6 - State Caught*
Trout Species #6 - Date Caught*

MonthDayYear
Date
Trout Species #6 - Water Body Caught*
Trout Species #6 - Gear Type*
Trout Species #6 - Trout Released?*
Trout Species #6 - Photo

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Trout Species #7
Trout Species #7 - Date Caught

MonthDayYear
Date
Trout Species #7 - State Caught
Trout Species #7 - Water Body Caught
Trout Species #7 - Gear Type
Trout Species #7 - Trout Released?
Trout Species #7 - Photo

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Trout Species #8
Trout Species #8 - Date Caught

MonthDayYear
Date
Trout Species #8 - State Caught
Trout Species #8 - Water Body Caught
Trout Species #8 - Gear Type
Trout Species #8 - Trout Released?
Trout Species #8 - Photo

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Trout Species #9
Trout Species #9 - Date Caught

MonthDayYear
Date
Trout Species #9 - State Caught
Trout Species #9 - Water Body Caught
Trout Species #9 - Gear Type
Trout Species #9 - Trout Released?
Trout Species #9 - Photo

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Trout Species #10
Trout Species #10 - Date Caught

MonthDayYear
Date
Trout Species #10 - State Caught
Trout Species #10 - Water Body Caught
Trout Species #10 - Gear Type
Trout Species #10 - Trout Released?
Trout Species #10 - Photo

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Trout Species #11
Trout Species #11 - Date Caught

MonthDayYear
Date
Trout Species #11 - State Caught
Trout Species #11 - Water Body Caught
Trout Species #11 - Gear Type
Trout Species #11 - Trout Released?
Trout Species #11 - Photo

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Trout Species #12
Trout Species #12 - Date Caught

MonthDayYear
Date
Trout Species #12 - State Caught
Trout Species #12 - Water Body Caught
Trout Species #12 - Gear Type
Trout Species #12 - Trout Released?
Trout Species #12 - Photo

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Trout Species #13
Trout Species #13 - Date Caught

MonthDayYear
Date
Trout Species #13 - State Caught
Trout Species #13 - Water Body Caught
Trout Species #13 - Gear Type
Trout Species #13 - Trout Released?
Trout Species #13 - Photo

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Trout Species #14
Trout Species #14 - Date Caught

MonthDayYear
Date
Trout Species #14 - State Caught
Trout Species #14 - Water Body Caught
Trout Species #14 - Gear Type
Trout Species #14 - Trout Released?
Trout Species #14 - Photo

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Trout Species #15
Trout Species #15 - Date Caught

MonthDayYear
Date
Trout Species #15 - State Caught
Trout Species #15 - Water Body Caught
Trout Species #15 - Gear Type
Trout Species #15 - Trout Released?
Trout Species #15 - Photo

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Trout Species #16
Trout Species #16 - Date Caught

MonthDayYear
Date
Trout Species #16 - State Caught
Trout Species #16 - Water Body Caught
Trout Species #16 - Gear Type
Trout Species #16 - Trout Released?
Trout Species #16 - Photo

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Trout Species #17
Trout Species #17 - Date Caught

MonthDayYear
Date
Trout Species #17 - State Caught
Trout Species #17 - Water Body Caught
Trout Species #17 - Gear Type
Trout Species #17 - Trout Released?
Trout Species #17 - Photo

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Trout Species #18
Trout Species #18 - Date Caught

MonthDayYear
Date
Trout Species #18 - State Caught
Trout Species #18 - Water Body Caught
Trout Species #18 - Gear Type
Trout Species #18 - Trout Released?
Trout Species #18 - Photo

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I certify that I caught the trout species are listed above. Signature*

Clear
Application Date*

MonthDayYear
Date
Should be Empty: