Blue/Gray Charity Deer Hunt 2011
January 13th, 14th & 15th
Please submit a separate form for each hunter registered.
Form may be filled out on the computer then printed to submit.
If form is filled out by hand Please PRINT legibly.
CLICK TO RETURN HOME

Name: 
Address: 
City:    State:     Zip: 
Home Phone:    Daytime Phone: 
Cell Phone: 
Email:  
Age:   Occupation: 
Land/Guide Request (Former Hunters): 
Group Hunting Request: 

Payment Method:
Check   *PayPal   Visa   MasterCard  
Credit Card No:
Security Code:** 
Exp. Date: /

Amount authorized to charge to credit card:

Signature: ___________________________________________   

        2-day standard hunt - $850

        Special Father/Child Package - $1200

        Per Additional family member - $300

      Optional Saturday afternoon hunt (Jan. 16th) - $175

      Blue Gray Premium Package - $1100

  *Hunters that pay using PayPal, must complete registration form and fax or mail it in.
**If paying by credit card, we will need the 3- or 4- digit security code found on the back of your card in addition to the 16- digit account number.

If paying by check, please make payable to:  The MLC Community Foundation.

Please fill out the above form, this page, and then follow the directions below.

Please return form to:  Montgomery Lions Club
                                  P.O. Box 94
                                  Montgomery, AL  36101   -OR-   Fax to:  334-356-1185