Outdoors Application

Please fill out both of the forms on this page. We will need an application in order to submit your name into the lottery system.

Submit an Application for an outdoors event

DATE YOU ARE SUBMITTING APPLICATION

Event Name *

NAME

Sex *

Male

Female

ADDRESS

Apt, suite, etc.

Country

City

State

Zip code

PHONE

AGE

WEIGHT

EMERGENCY CONTACT NAME

EMERGENCY CONTACT PHONE

DISABILITIES

DESCRIBE DISABILITIES

PLEASE DESCRIBE ANY DISABILITIES THAT WILL EFFECT YOUR ABILITIES OUTDOORS

MEDICATIONS

PLEASE ANY MEDICATIONS YOU ARE TAKING IF NONE WRITE NONE

Date OF LAST MEDICAL CHECK UP

NAME OF MEDICAL PROVIDER

ALLERGIES

LIST ANY ALLERGIES

Have you been on a DAV trip Before *

Yes

What Year and trip were you on?

Last time you were Fishing or Hunting

PLEASE PROVIDE A ROUGH TIME FRAME OF WHEN YOU WERE LAST OUTDOORS

LAST TIME YOU FIRED A WEAPON

WHEN WAS THE LAST TIME YOU SHOT A GUN?

DO YOU HAVE YOUR OWN WEAPON/FISHING POLE?

IF YES YOU HAVE YOUR OWN WEAPON, WHAT DO YOU HAVE?

IF YOU HAVE A FISHING POLE IS WHICH IS IT?

BRANCH OF SERVICE

RANK

TIME OF SERVICE

HOW MANY YEARS OF SERVICE

DO YOU HAVE YOUR OWN TRANSPORTATION TO THE EVENT?

Captcha *