Michigan Bow Hunters Out of State Award Application This section MUST be filled in completely to receive any award. In order to be eligible for and to receive a MBH Out-of- State Award, MBH membership MUST be active at the time the animal is taken and the animal must be recovered in accordance with Pope and Young rules. No award will be given for animals taken on enclosed hunting preserves. Also, Out-of-State license or kill tag or photocopy must accompany application. Only ONE animal is allowed per application sheet. Failure to fill in all the lines properly on this side of the application or failure to attach license or permit or kill tag or copy thereof, will result in application being returned and NO award will be given. Are you applying for your First (1^st) Out-of-State award? Yes No Name: Male Female Date of Birth (mm/dd/yyyy) Street Address City State MI AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Phone number (xxx-xxx-xxxx) Animal taken: Sex F M # of Points Date of Kill Time AM PM State / Province or Country taken in Name of Outfitter or Guide By submitting this application, I hereby certify that the above information is accurate and that the animal was taken in accordance with the rules of fair chase as stated in the MBH constitution and bylaws. Date Submitted Name, address, & phone number of person verifying animal was taken by applicant: Applications Submitted later than January 15^th Will NOT be honored. Supporting documentation (license, permit, copy of kill tag, etc.) can be scanned and emailed to dfrein@verizon.net or you can mail copies to: MBH Awards Director, Dan Frein, 833 Carlton St., Muskegon, MI 49442

Bowhunting Questionnaire (Optional) Thank you for taking time to fill in the following optional information. Age of animal if known Pope and Young Score Animal was taken on: Private Land Public Land Length of Recovery Time Distance Animal Traveled Was Bait Used? Yes No If Yes, what type of bait(s)? Hunting Method used to take animal: Tree Stand Ground Blind Stalking/Still Hunting Animal Was: Walking Standing Running Other Animal Shot Position: Broadside Quartering Away Quartering Forward Facing You Shot Distance Hit Location Organs Penetrated Bones Cut or Broken Name of Bow Compound Recurve Longbow Bow Weight # % Let off Arrow Type Aluminum Carbon Wood Other Broadhead Name Number of Cutting Edges 2 3 4 5 6 Years Hunted with a Bow Years Member of MBH # Days Hunted for this animal species # Shots Taken # Animals seen # Animals Shot but NOT Recovered Would you recommend this guide or outfitter to MBH members? Yes No Comments: