Contact Person's Name:

Contact Person's Address:

City:

State:

Zip:

Email Address:

Work Phone:

(       )

Home Phone:

(       )

Fax Number:

(       )

Cell Phone:

(       )

Organization Name:

Organization Headquarters Location (distance & direction from nearest town):

Dates of Field Events, Type of Event (ex: Night Hunt, Field Trial, Water Race or Treeing Contest) and Licensing Organization (AKC, ACHA, NKC, PKC, UKC or Club Event):

County or counties in which these events will be conducted:

Signature of the Applicant

Request must be received at least four weeks prior to the date of the field trial.

This permit is only valid on properties where permission has been secured from the landowner/tenant to pursue game by individuals associated with the competitive field event and/or their dogs. Failure to comply with this provision is a violation of 520 ILCS 5/2.33(t), which is a Class B misdemeanor punishable by 1-6 months in jail and/or fines of up to $1,500.

Submit application to: IDNR, Attention: Field Trial Program, One Natural Resources Way, Springfield IL 62702-1271; Phone:  (217)782-6752; Fax:  (217)524-5612