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Five Oaks Duck Lodge
P.O. Box 586
DeWitt, Arkansas 72042

Note: Mandatory fields are marked with an asterisk ( * ).

Personal Information

First Name: * Middle Name: * Last Name: * Arrival Date: * Home Phone: * Cell Phone: E-mail: Host Name:

Address

Address: *  City: *  State: *  AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NV NH NJ NM NY OH OK OR PA PR RI SC SD TN TX UT VT VA WA WI WV WY ZIP: *

License Details

Do you have an Arkansas hunting license? Yes No Arkansas hunting license #:     If you do not have an Arkansas license, please complete this green section. If your driver's license number is the same as your social security number, and you are concerned about transmitting that number across the Internet, we recommend you click here for a PDF version of this form , print it out and mail it to us. Driver's License Number: State: *  AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NV NH NJ NM NY OH OK OR PA PR RI SC SD TN TX UT VT VA WA WI WV WY Date of Birth: Hair color: Eye Color: Height:     Do you have a Federal Duck Stamp? Yes No Do you have any allergies or special medical needs? Emergency Contact: Do you want processed ducks? Yes No If yes... Ship Them To Me I Will Take Them With Me If shipped, what is your shipping address?: Same as Above See Below Address: City: State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NV NH NJ NM NY OH OK OR PA PR RI SC SD TN TX UT VT VA WA WI WV WY ZIP: