(All fields required)
First Name:
Last Name:
MI:
DoB:
Address:
City
:
State:
Zip Code:
Phone:
E-mail address:
Passport Number:
Exp. date:
Country:
Incomplete forms can not be processed. Please enter ALL information requested
(All fields required)
I will rent a shotgun
none
12 ga semiauto
20 gauge semiauto
12 ga O/U
20 ga O/U
Make:
Model:
Main Gauge:
12
16
20
28
.410
Secondary gauge:
none
12
16
20
28
.410
Barrel length:
Serial Number:
Registered on form 4457:
Yes
No
Second shotgun data:
Make:
Model:
Main Gauge:
12
16
20
28
.410
Secondary gauge:
none
12
16
20
28
.410
Barrel length:
Serial Number:
Registered on form 4457:
Yes
No
Select your Hunting date from below.
Arrival date:
March 27-30, 2009
June 26-29, 2009
September 25-28, 2009
December 11-14, 2009
March 26-29, 2010
To be determined
Special requests: (medical, dietary etc.)
South America Wingshooting
25508 Wyngate Ct. Flat Rock, MI 48134 - Phone: 734-709-1475
