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First Name
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Last Name
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Home Phone
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Mailing Address
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City
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State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Montana
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Nevada
New Hampshire
New Jersey
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New York
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
*
Cell Phone
Email Address
*
Age
*
Under 20
20-29
30-39
40-49
50-59
60-69
Over 70
Who do you usually hunt with?
Friends
Family
Alone
What counties would you like to hunt
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Dodge
Dakota
Washington
Saunders
Knox
Cass
Garfield
Other
If other, list:
What type of game do you want to hunt?
*
Mule Deer
Whitetail Deer
Turkey
Duck
Goose
Pheasant
Quail
Coyote
Bobcat
Rabbit
Squirrel
Prairie Dog
Dove
Camping
Fishing
Raccoon
Grouse
Other
If other, list:
Weapon preference:
Rifle
Shotgun
Muzzleloader
Handgun
Archery
Crossbow
Other
If other, list:
How did you hear about us?
*
Member Referral
Facebook
Twitter
Craigslist
Saw Posted Sign on Property
Print Advertisement
Internet Advertising/Search Engine
Direct Mail Advertisement
Other
If member referral or other, list:
How much time did you spend on our website?
*
Less than 2 minutes
2-5 minutes
5-10 minutes
10-20 minutes
20-30 minutes
More than 30 minutes
Any additional comments - tell us about yourself and what you are looking for...
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