NCBA-Hall of Fame

Name: ____________________________________________________________________________

Address: __________________________________________________________________________

City/St/Zip: ________________________________________________________________________

Phone: (Work) (_____)___________________ Cell #: (______)_____________________________

County of Residence:_______________________________________; Wildlife District: __________
Date of Birth:_________________;
Sex: Male_____ ; Female: _____.
NC Driver Lic. No. ___________________.
"Other" Driver Lic. No. ____________________ State? _______
What is your occupation? __________________________________
Do you belong to a NCBA Local Chapter Archery/Bowhunting Club? _______.
Do you belong to any other Archery/Bowhunting Club? ___________.
Name of Club: _____________________________________
How long have you been a NCBA Member? _______________ (Years)
Are you a NCBA Lifetime Member? _________.
How long have you been bowhunting ? ________ . (Years?)
How many BIG GAME animals have you harvested with bow and arrow? (NO CROSSBOWS!)- ____________ .
Have you ever been convicted of any type wildlife violation anywhere? ________. If YES, please explain and give details on back of page, or on separate page attachment.

Attach "copies of certificates" from "Hunter Safety" and "Bowhunter Education (IBEP)” Courses completed.

References: (Two required; -No immediate family relatives please!)

1-Name: __________________________________ NCBA Member? ________ Yes - No
Phones: (H)-_____________________ (W)-_____________________ (Cell)-_______________________

2-Name: __________________________________ NCBA Member: ________ Yes - No
Phones: (H)-_____________________ (W)-_____________________ (Cell)-_______________________

Below are the guidelines for being approved as a “BCRS-APT Certifier.”
Please “check” ALL of them that apply to you.

Persons who may be qualified to administer the BCRS qualification tests are NCBA Members who are:
____ a.    Any “present or past” NCBA E.C. or A.C. officer.
____ b.    NCBA official measurers.
____ c.    Officers/Designees of Local Chapter Clubs.
____ d.    NCBA-IBEP Instructors.
____ e.    NCBA members who operate public or private, indoor or outdoor ranges. (*These members must be
certified by any ONE of the five options listed in “a, b, c, d, or e” above. A fee may NOT be charged to administer the BCRS-BCPT test. Nor shall BCRS applicants be required to patronize their establishment in any manner, form or fashion.) Record name, address & phone number(s) of business/range, etc., on back or separate attachment.

I AFFIRM that the information above is true and factual to the best of my knowledge. If this application is approved and accepted, I agree to comply with all rules, regulations and requirements as set forth by the NCBA-BCRS Program. I understand that any falsification or omission of pertinent information in this application is grounds for disqualification of BCRS certification at any time.

Signed: _____________________________________ Date: __________________

Print Name: __________________________________

Witnessed By: ________________________________ Date: __________________

Witness Phone: _______________________________

1.    Mail completed application to:
                        Jeff Morrison, NCBA-BCRS
                        104 Goneaway Lane
                        Cleveland, NC 27013

2.    After the BCRS has received and processed your application for “BCRS-APT Certifier,” you will receive notification that BCRS has received it. You will receive a BCRS-APT Certifier ID number and “Letter of Acceptance” which is valid until cancelled by you or the NCBA-BCRS Committee.

3.    There is NO application deadline.

4.   The address of our web page is: www.ncbowhunter.com/BCRS.htm .    This site contains information and news regarding BCRS programs and activities, such as upcoming hunt plans, hunt draw (lottery) information, BCRS application forms, rules, regulations, member roster and roster of “BCRS-APT Certifiers.” Members are encouraged to check the website periodically for new information and developments.   Updates may be included in the quarterly NCBA magazine. Periodic mailings to the entire BCRS membership via U.S. Mail will NOT be done. To control and reduce operating costs, our primary source of disseminating BCRS information will be via our website, the NCBA magazine and emailings.