Application – Hunters Frontline

Injured Party
Name*
First Last
Country of Permanent Residence*
Email
Phone
Party submitting this request
(if different than Injured Party)
Name
First Last
Email
Phone
Professional Hunting Association / Affiliation
Is the Injured Party a member of good-standing with a Professional Hunter’s organization in the country in which the incident occurred?*
- Yes
- No
If so, please state the Professional Hunting Organization Name
Details of Incident
Is the Injured Party Currently Hospitalized?*
- Yes
- No
If so, please note the name of the medical facility
Please provide a written explanation of events of the incident that resulted in injury*
Amount Requested*
Date Submitted*
MM slash DD slash YYYY

Injured Party