____________________________________________________________________________________________________________
APPLICATION
COMPETITIVE FIELD TRIALS PERMIT
Fee: $31
(22.74)
Please PRINT all information except for your signature. Incomplete or illegible applications will be returned.
PROCESSING TIME: Allow thirty (30) days.
I hereby make application for a permit to hold a field trial.
TAX ID:
SPORTSMAN’S ID or SSN:
DATE OF BIRTH:
APPLICANT INFORMATION
NAME [LAST]
[FIRST]
[MIDDLE]
:
ORGANIZATION
:
PHYSICAL ADDRESS
:
:
:
CITY
STATE
ZIP
:
MAILING ADDRESS
:
:
:
CITY
STATE
ZIP
:
:
:
HOME PHONE
WORK PHONE
E-MAIL ADDRESS
:
:
:
:
:
HEIGHT
WEIGHT
HAIR
EYES
GENDER
:
:
DRIVER’S LICENSE NUMBER
STATE
DATE ISSUED
:
OCCUPATION
EMPLOYER:
1. Location of field trial (legal description or name of property): _____________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
2. Date(s) of field trial: _____________________________________________________________________
3. Species of Upland Game Birds: ___________________________________________________________
4. Source of Birds/Vendor License No.: _______________________________________________________
5. Number of birds to be released: ___________________________________________________________
I, the signator, in signing this application, hereby state that I am entitled to this permit under the laws of the
State of Nevada and that no false information or false statement has been made by me to obtain this license.
_____________________________________________________________
__________________________________
Signature of Applicant
Date
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.74
Rev. Oct 2010
Page 1 of 2
____________________________________________________________________________________________________________
APPLICATION
COMPETITIVE FIELD TRIALS PERMIT
Fee: $31
(22.74)
Please PRINT all information except for your signature. Incomplete or illegible applications will be returned.
PROCESSING TIME: Allow thirty (30) days.
I hereby make application for a permit to hold a field trial.
TAX ID:
SPORTSMAN’S ID or SSN:
DATE OF BIRTH:
APPLICANT INFORMATION
NAME [LAST]
[FIRST]
[MIDDLE]
:
ORGANIZATION
:
PHYSICAL ADDRESS
:
:
:
CITY
STATE
ZIP
:
MAILING ADDRESS
:
:
:
CITY
STATE
ZIP
:
:
:
HOME PHONE
WORK PHONE
E-MAIL ADDRESS
:
:
:
:
:
HEIGHT
WEIGHT
HAIR
EYES
GENDER
:
:
DRIVER’S LICENSE NUMBER
STATE
DATE ISSUED
:
OCCUPATION
EMPLOYER:
1. Location of field trial (legal description or name of property): _____________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
2. Date(s) of field trial: _____________________________________________________________________
3. Species of Upland Game Birds: ___________________________________________________________
4. Source of Birds/Vendor License No.: _______________________________________________________
5. Number of birds to be released: ___________________________________________________________
I, the signator, in signing this application, hereby state that I am entitled to this permit under the laws of the
State of Nevada and that no false information or false statement has been made by me to obtain this license.
_____________________________________________________________
__________________________________
Signature of Applicant
Date
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.74
Rev. Oct 2010
Page 1 of 2
The completed application with the required fee shall be submitted to the Regional Manager of the
administrative region where the competitive field trials will be held.
Western Region
Southern Region
Nevada Department of Wildlife
Nevada Department of Wildlife
Special Licenses and Permits
4747 Vegas Dr.; Las Vegas, NV 89108
1100 Valley Rd, Reno, NV 89512
Telephone: (702) 486-5127
Telephone: (775) 688-1500
Counties: Clark, Esmeralda, Lincoln, Nye
Counties: Carson City, Churchill, Douglas,
Humboldt, Lyon, Mineral, Pershing, Storey,
Washoe
Eastern Region
Nevada Department of Wildlife
60 Youth Center Road; Elko, NV 89801
Telephone: (775) 777-2300
Counties: Elko, Eureka, Lander, White Pine
FOR DEPARTMENT USE ONLY
Date Received: _______________
Date Approved: _______________
Date Returned for Additional Information: __________________
Date Disapproved: _______________
Department Representative:_____________________________
REASON FOR DISAPPROVAL:
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.74
Rev. Oct 2010
Page 2 of 2