Registration Form

Group Leader *

First Name *
Last Name *
Email *
Phone *
Alternate Phone
Address on Drivers License *
City *
State * AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces AfricaArmed Forces Americas (except Canada)Armed Forces CanadaArmed Forces EuropeArmed Forces Middle EastArmed Forces PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPalauPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory

Post Code *
Last 4 of SSN *
Drivers License # *
Date of Birth *
Emergency Contact *
Emergency Phone *

Note: Pick ups in Sioux Falls are between Noon and 3pm - Drop offs on departure day are 9am to Noon. (please work with your group to coordinate similar arrival and departure times). Transport to and from Sioux Falls to the lodge is 2 hours.

Do you need pick up from the Sioux Falls airport? *
If driving to the lodge approximate arrival time? *
Arrival Date *
Arrival Time
Airline & Flight # *
Departure Date *
Departure Time

Are there any special dietary needs?
Do you have any physical needs or concerns?
Would you like a specific guide if possible? No/Yes (If yes, guides name)
Do you need to rent a gun?
Are you bringing any dogs?
Hunters Safety # (hunters under 16)

Special Request: