State of Alaska s5

STATE OF ALASKA DEPARTMENT OF FISH AND GAME APPLICATION for EDUCATIONAL PERMIT

PERMIT to possess game parts for EDUCATIONAL PURPOSES.

I, of (name) (organization or institution)

(address)

(telephone number) (fax number)

(cell phone number) (e-mail address) hereby make application for a permit to receive from the Alaska Department of Fish and Game and possess indefinitely the following items (attach additional sheets if necessary):

Species (Common or Scientific Name) Item Description (hide, skull, etc.) Number

Please describe the educational program or activities for which these items are being requested (attach additional sheets if necessary):

I certify that all statements entered on this application are true and that I will abide by all conditions and restrictions of a permit if issued,

(Signature) (Date) Completed applications should be submitted to: ADF&G, Division of Wildlife Conservation ADF&G, Division of Wildlife Conservation 333 Raspberry Rd. or 1300 College Rd. Anchorage, AK 99518 Fairbanks, AK 99701