MARTHA'S VINEYARD LAND BANK GENERAL HUNTING PERMIT APPLICATION

DOES NOT INCLUDE DEER SHOTGUN SEASON

2024 SEASON

First Name *

Last Name *

Mailing Address *

City, State, Zip (PLEASE GIVE YOUR
FULL MAILING ADDRESS so I know
where to send your tree stand tag.) *

Phone
Number *

Email Address *

Year, Make, Model, License Plate of vehicle used for hunting *

Season Requested

	Ducks/Geese	Pheasant
Please check boxes	Ducks/Geese	Pheasant

Season Requested

	Raccoon	Rabbit
Please check boxes	Raccoon	Rabbit

Hunting Agreement *

I hereby certify that I have read, understand and agree to abide by the land bank commission hunting policy, receipt of which is hereby acknowledged. In consideration for permission to enter and use land bank commission property for the purpose of hunting, I hereby release the land bank commission and any of its employees and agents from any liability for damage or injury to me or my property arising out of my use of such land bank commission property. I further agree on behalf of myself, my heirs, successors and assigns to indemnify and otherwise hold harmless the land bank commission and any of its employees and agents from any loss, injury, damage, claim or expense arising out of my use of land bank commission property, including reasonable legal expenses in connection therewith.