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

	Youth Deer Hunt Day	Deer Archery	Deer Muzzleloader
Please check boxes	Youth Deer Hunt Day	Deer Archery	Deer Muzzleloader

Season Requested

	Ducks/Geese	Pheasant
Please check boxes	Ducks/Geese	Pheasant

Season Requested

	Raccoon	Rabbit
Please check boxes	Raccoon	Rabbit

Season Requested

	Fall Turkey
Please check boxes	Fall Turkey

Tree Stand Tags: Numbered identification tags are required on all tree stands erected on Land Bank property. If you have tags from prior years, you may continue to use them. New tags can be picked up at the Land Bank office. Please indicate how many tags you would like.

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.