Hunter Registration Form:

Name: __________________________________________________

Signature: _______________________________________________

Company Name (optional): __________________________________

Address: _________________________________________________

City: _________________ State: ____________ Zip: ____________

Phone: ________________ E-mail: ___________________________

Pheasant Package: Corporate Group Individual (circle one)

# of extra birds: ________ x $17 or $18 or $20 or $22 (circle one)

Payment amount enclosed (includes sales tax): ________________

Additional hunters for group and corporate plans:

Name: _________________________________ Phone: ___________

Signature : ____________________ Date of Birth: _______________


Name: _________________________________ Phone: ___________

Signature : ____________________ Date of Birth: _______________


Name: _________________________________ Phone: ___________

Signature : ____________________ Date of Birth: _______________


Name: _________________________________ Phone: ___________

Signature : ____________________ Date of Birth: _______________


Name: _________________________________ Phone: ___________

Signature : ____________________ Date of Birth: _______________


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Print and cut on dotted line above

All hunters must print and sign the registration form and send with
payment to:

Little Creek Lodge
Pheasant Hunting Package
4219 Sampson Road
Little Suamico, WI 54141


Little Creek Lodge and its officers and employees assume no responsibility for the safety of participants in any event. All participants recognize and agree by their participation that safety shall be their exclusive responsibility and hereby waive any right to seek recovery for any injury or damage which may be incurred, either to person or to property as a result of or in connection with this event or participation herein.

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