Debra Card Courage Award

Debra Card Courage Award Application (Application Deadline July 1st of current year)
Applicant
First Name :
Last Name :
Address :
City :
State :
Zip Code :
Phone :
Email :
Sponsor
First Name :
Last Name :
Address :
City :
State :
Zip Code :
Phone :
Email :
Brief history of applicants/physical disability, when did it occur, extent of disability :
How the Disability occured :
List and Describe rehabilitation efforts :
Explain any usage of adaptive equipment, special training, or assistance required for applicant to hunt :
Describe hunting experiences since disability :
Please list any conservation, hunting, and/or shooting organizations to which the applicant currently belongs or participates :
Describe any disabled hunting, shooting, and/or conservation projects or activities which the applicant has organized or particapated in :
Any details about the applicant which makes him/her especially unique :
Additional Information :
You are welcome (but not required) to attach up to two photos and two letters of recommendation from persons who are familar with your interest and involvement in shooting and hunting. * Debra Card Courage Award winners are required to sign a waiver and release of liability *