Windham-Gorham Rod and Gun Club
     Maine Youth Lifetime License Lottery Application


  All applicants must be Maine residents and under 16 years of age at time of application. Any funds allocated are at the discretion of the Windham Gorham Rod & Gun Club Board of Directors. Parents/guardians  must ensure the timely submission of all required documentation to the State.

Name of Member in Good Standing:    


Member Contact Info:


Nominee Name:    


Relationship to Member:  


Nominee DOB:  


Parent/Guardian Name:  


Parent/Guardian Contact Info:  


Nominating Member Signature: 


Date: