As a member in good standing of the Wyoming State Archery Association,
I am stating that I have taken with a bow and arrow the following number of
big game animals in the state of Wyoming with the bow and arrow under
the rules of fair chase while I have been a resident of the State of Wyoming.

Number of Animals I have taken in the State of Wyoming while a member
in good standing of the Wyoming State Archery Association under the
rules of fair chase with the bow and arrow is:_____

The number of animals include the following:
Circle those taken:

Mule Deer     Whitetail Deer     Elk     Moose     Antelope     Bighorn Sheep

Black Bear     Mountain Goat     Mountain Lion

OTHERS: __________________________________________________

__________________________________________________________

If my number of animals is less than ten, this is a statement of my
archery hunting achievements to be kept by the Vice President of
Bowhunting of the Wyoming State Archery Association for use in
determining if I have met the criteria of meeting the ONE TIME
bowhunting achievement award of the association's Bowhunter's
Honor Roll of ten big game animals.

I affirm that my statements of achievement of bowhunting archery
are accurate and correct.

NAME: _________________________________________________________

ADDRESS: ______________________________________________________

DATE OF STATEMENT: ___________________________________________

Return this form to the Vice President of Bowhunting of the Wyoming Archery Association.

Thank You,

Current Vice President of Bowhunting:

Neal Perkins
2415 Channell Drive
Cheyenne, WY. 82009
buglelk@aol.com