Deibler Outdoors, Inc.

Pre-Hunt Questionnaire

Submission options:

Submit this form on line or print this page and fax to: 770/831-7101.

Return to Deibler Outdoors CLICK HERE

  1. Please provide the following contact information:

    Name
    Title
    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Work Phone
    Home Phone
    FAX
    E-mail
    URL

  2. Please identify and describe yourself:

    Name
    Date of Birth
    Sex Male Female
    Height
    Weight

  3. How would you describe your physical condition::

    ExcellentGoodFairWrecked

     

  4. Are you a smoker?

    yes
    no

  5. List any physical ailments, medical conditions or medications needed:


  6. Name and phone of emergency contact:


  7. Description of past guided or unguided hunts, good or bad. Please include type, location, result and how you felt about the hunt.


  8. Hunting Interests, Select any of the following options that apply:

    Deer      Elk       Moose     Antelope
Bear      Fowl      Big Game  Fishing

  9. If you are interested in a particular Deibler Outdoors hunt or trip, enter the Trip # and description here:


  10. Hunting weapon of choice:

    ArcheryMuzzleloaderRifle

  11. Years of hunting experience:


  12. Firearm make and caliber:


  13. Bullet weight and brand:


  14. What is your maximum effective shooting range?


  15. If you shoot a bow, what kind?

    CompoundRecurveLongbow

  16. Other comments or questions:



Copyright  2005 [Deibler Outdoors, Inc.]. All rights reserved.
Revised: 03/13/05