PROPHET MUSKWA AT YUKON

Box 6677

Ft. St. John, British Columbia, Canada

V1J 4J1

(250) 789-9494

FAX (250) 789-3282

HUNTING LICENSE, ROYALTIES & SPECIES TAG INFORMATION

YUKON TERRITORY, CANADA

PLEASE FILL IN APPROPRIATE INFORMATION AND RETURN WITH YOUR CHECK AS SOON AS POSSIBLE. MAKE CHECKS OUT TO PROPHET MUSKWA. YOUR LICENSE AND TAGS WILL BE PURCHASED AND WAITING FOR YOUR ARRIVAL IN CAMP. CHECKED ITEMS ARE COMPULSORY.

NAME: __________________________________________________________________________

ADDRESS:_______________________________________________________________________

CITY, STATE, ZIP:____________________________________________________

TELEPHONE: _______________________FAX ____________ EMAIL_______________

DATE OF BIRTH____________HEIGHT__________WEIGHT:_____________SS# ____________

HUNT DATES: _____ __CREDIT CARD # ____________________________

To guarantee room reservations only

_X_ NON RESIDENT HUNTING LICENCE $150.00____________

_X_ NON RESIDENT HUNT PRESERVATION FUND $135.00____________

___ SHEEP SEAL $10.00____________

___ MOOSE SEAL $5.00____________

___ CARIBOU SEAL $5.00____________

___ GRIZZLY SEAL $25.00____________

___ BLACK BEAR SEAL $5.00____________

___ FISHING LICENSE $35.00___________

TOTAL___________

7% GST ___________

TOTAL IN CANADIAN FUNDS ___________

FOR U.S. FUNDS x .85% ___________

TOTAL IN U.S. FUNDS ___________

_X_TRANSPORTATION PER PERSON RT FROM WHITEHORSE in US dollars _$1,000.00__

TOTAL AMOUNT ENCLOSED ___________

SPECIAL DIET REQUEST:________________________________________ ________________________________________________________________