5 Oaks Duck Lodge :: Hunter Registration

Hunter Registration

Please fill out this form to register with us. Or, if you prefer, you can click here for a PDF version of this form

print it out and mail it to us at:

Five Oaks Duck Lodge
1895 Highway 152
Humphrey, AR 72073
870.873.4444

* indicates a required field
*Name:
*Home Address (Street):
*City:
*State:
*Zip:
*Home Phone:
Cell:
E-mail Address:
Host Name:
*Arrival Date:
*Do you have an Arkansas hunting license?
Arkansas Hunting license #
The following information in red is not needed if you have an Arkansas license.
Driver’s License Number:
State:
DOB:
Hair Color:
Eye Color:
Height:

Do you have a Federal Duck Stamp?
Do you have any allergies or special medical needs?
*Emergency Contact:

Do you want processed ducks? Yes No If yes ... Take with you?
Ship to you? If shipped, what is your shipping address?:

Street Address:
City:
State:
Zip:

Five Oaks Duck Lodge
1895 Highway 152
Humphrey, AR 72073
870.873.4444