* Name: * Address: * City: * State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY * Zip: * Phone: Email Address: * Gender: Male Female * Age: * Years of Hunting Experience: * Number of Years Disabled: * Have you ever participated in one of our hunts? Yes No Choose your income level: $15,000 or less $15,000 - $30,000 $30,000 - $45,000 $45,000 - $60,000 over $60,000 * Number of deer taken since disabled: * Number of deer taken with bow since disabled: Describe your disability: * Are you in a wheelchair? Yes No * Can you be easily transferred into a 4WD for transporting? Yes No * What style of bow do you shoot? Traditional Compound Crossbow * Do you have a Hunter Trapper Safety Certificate? Yes No * Have you taken the Bowhunter Education Program? Yes No * Are you a member of the UBP? Yes No How did you hear about the UBP Disabled Hunter Program?
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