NEW YORK POWER AUTHORITY
BLENHEIM-GILBOA POWER PROJECT ARCHERY HUNT

2010 ARCHERY PERMIT APPLICATION

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Last Name                               First Name                              M.I.                 Date of Birth

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Resident Big Game License #                        Archery Document #              Issuing Agent

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Vehicle Make              Year                Color   License  #                    Home Phone  #

 

Mailing Address

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City                                                                 State                                        Zip Code

 

ATTACH A PHOTOCOPY OF YOUR PROFICIENCY CERTIFICATION

You must have satisfactorily completed the shooting proficiency portion of the Bow hunter Training program as well as provide all of the above information to qualify for a permit.

Incomplete or illegible applications will be discarded without notification of the applicant.  Falsification of any part of this application or of the information required will be cause for automatic revocation of your permit. Revocation of a permit will place your name on an ineligible list and future applications will be denied.

The New York Power Authority recognizes that with any sport or recreational activity there is a risk of personal injury or death through accidents, careless acts of the individual and acts of others.  Your signature on this application is an acknowledgment of your complete understanding of all the risks involved with hunting.  You agree to accept those risks and hold harmless the New York Power Authority for any accident, injury or death sustained while you are on Power Authority property.

Signature_____________________________________Date_________________

On or before September 25th, mail completed application and copy of proficiency certification to: New York Power Authority, 2010 Archery Hunt
1378 State Route 30 P.O. Box 898, N. Blenheim, NY  12131