MAINE BOWHUNTERS ASSOC.
P.O. Box 5026
August, Maine 04332-5026
APPLICATION FOR ADVANCED BOWHUNTER PROGRAM
PLEASE PRINT NEATLY
Last Name __________________________________________________ Date ________________
First Name _______________________________________________________ M.I. __________
Mailing Address __________________________________________________________________
Street Address ___________________________________________________________________
City/Town __________________ State _______ Zip Code _________ County _____________
Telephone (home) _____________________ E-mail Address ____________________________
Drivers License Number (For background check only) _______________________________
Date of birth (mm/dd/yy) _________________________________________________________
Bowhunter Safety Certificate Number _________________ Current MBA member? YES NO
YES NO Have you ever had a revocation of ANY license issued by IF&W in the past
10 years?
YES NO Have you been convicted of ANY IF&W law violation? If so, give date(s)
and a brief explanation.
_______________________________________________________________________
_______________________________________________________________________
YES NO Are you a convicted felon?
YES NO Have you legally tagged two deer, harvested with a bow, in
Maine, within the past five years?
If yes, fill in data below. Put the number of deer harvested in the
corresponding line.
DEER ____ YEAR(S) _____________ Tagging Station _____________________________
By signing this application, I do solemnly swear that the above information is
correct, and give my permission to the MBA to verify information with the DIF&W
and local authorities.
Signature: _____________________________________________ Date: __________________
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FOR INSTRUCTOR USE ONLY
Instructor Name: _________________________________________ Card issued? YES NO
If not, please state reason: _____________________________________________________