Welcome to BuckDaddys!  As a BuckDaddy, you and your family have access to all of our properties while still maintaining a unique exclusive hunting area on the property you are assigned to year round, and for many years to come!  We are accepting applications for the 2016/2017 membership year which will be processed on or after 2/1/16 for the year beginning 4/1/2016.  Please submit your wait list application ASAP if you want to be considered for any openings for the upcoming season. Become a BuckDaddy today!  Great Land, Great Members, and Great Times!  BuckDaddys - The Club of Choice!

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FAMILY TRADITION • FAMILY FUN

   Welcome to BuckDaddys Hunting Club, with approximately 8,000 acres of great hunting in the beautiful backdrop of East Texas.  BuckDaddys is devoted to sharing the great sport of hunting with others and to teaching our youth how to preserve wildlife, appreciate natural resources, enjoy the woods and outdoor experience, and to foster the love of hunting for generations to come.  BuckDaddys offers family outdoor recreational activities with the feeling of close knit family should you choose that experience, or solitude should you prefer to be on your own, all the while maintaining safe practice standards for the protection and safety of everyone.  Simply put, that's what we are all about.        

    Although members can come out alone (and many do), BuckDaddys also encourages its members to bring their immediate family regardless of whether they hunt or not.  We have memberships for everyone: individuals, wives, husbands, children, brothers, sisters, friends, co-workers, and everyone in between!  We always strive to maintain a good family atmosphere that any wife and child can be comfortable in and enjoy being a part of.  Our members not only hunt but also enjoy camping, riding, hiking, and sitting around the camp fire while eating from over the fire or from their camper and bragging about the day's events each evening.  

    BuckDaddys' membership is year round, not just for the hunting season. BuckDaddys offers plenty of areas for horseback riding, 4-wheeling, off-road riding, hiking and even fishing.  It's without doubt a great place to get away from the city and your job and enjoy the great outdoors stress-free -  any time of the year.  Although it goes without saying, there are plenty of opportunities for great photo sessions with critters amongst the natural backdrop of lofty pines.  The great outdoors, getting away from city life, fostering family traditions through hunting and other outdoor activities, and having a ton of fun...that's what we're all about. 

     Some properties have electricity, and some do not.  Many members prefer to bring their own generators, campers, trailers, tents and water, and enjoy their experience as they prefer.  BuckDaddys is conveniently located by/on two fantastic lakes as well:  Sam Rayburn and Toledo Bend.  Our 428 shares a border/boundary with Toledo Bend Lake.  (See the picture under MAPS).  These lakes have some of the world's best large mouth bass fishing around!

     Become a "BuckDaddy" today!  We take pride in keeping our membership dues lower than most clubs so to make BuckDaddys the Club of Choice in East Texas and to keep our members returning for years and years to come....after all....we're family!!!

2016/17 MEMBERSHIP PROCESS

EASY AND CONVENIENT!

2016/17 Membership Year

- New Memberships and Renewals -

      Thank you for your interest in BuckDaddys Hunting Club.  We look forward to having you stay or join BuckDaddys for the 2016/2017 Membership Year!  We have great grounds, great rates, great land managers, and great members that all help to make BuckDaddys the best choice for your outdoor recreational activities. 

   Although costs are on the rise, we have worked very hard to NOT raise rates for our members over the past several years and are pleased to announce that membership rates will remain at the low and reasonable rate of $720 for you and your entire eligible family, while offering you the same great amenities, including member's spouse and kids under 18 get to enjoy the same benefits you do for this one low price.  In addition, we have replaced the camper fee with a camp fee of a low $12.50 a month which allows 12 months of worry free camping on all our properties pursuant to the bylaws.

     BuckDaddys believes in carrying on the outdoor tradition to the next generation, and because of that, we strive to keep our rates as low as possible without compromising your experience so that anyone who wants to join may do so.  We are embarking on a great season with many exciting new programs for the upcoming year.  We hope to share them with you too, so come aboard and see for yourself!

Membership Process

  We are excited for this year to come and excited that you are interested in joining!  We truly have a great club: Great members, great land, great wildlife, great land managers, great friends and great times!  To renew or join our family, we have simplified everything this year!!!!  You can go to one place to submit your application, sign your bylaws, and submit your payment!

 

Current Members:  Select "Renew Membership"

New Applicants:   Select "Join Now"

 

     We look forward to you becoming a BuckDaddy! 

Definitely the beginning of many Great New Memories!

 

KEY DATES

 

January 1 - January 31 -  Current Members:  Renewal applications to lock in your current location or put in for a property transfer.  If you do not submit your renewal during this timeframe, you will be placed in line for your property of choice alongside new membership applicants.

 

December - January 31 - New Member Applicants:  You may submit your application and payment and be placed on a WAIT LIST.  No payments will be processed until after January 31 after we know how many openings we will have on each property and whether we can accept your application.  If accepted, your payment will be processed immediately on or about February 1st for the 2016/2017 membership year per the bylaws agreement you signed.  You may withdraw your application any time prior to January 30th by email pursuant to the terms of the Bylaws Agreement.

 

February 1st Forward - BuckDaddys will process all wait list applications and continue to accept new membership applications until all properties are full. Act ASAP to ensure membership!  We do fill up quickly so don't wait!

 

Questions - Please Call 817-805-2217

 

WELCOME TO BUCKDADDYS!

 
 

 

ALL MEMBERS

 

The only official website is

 

www.buckdaddyshuntingclub.com

 

our sister site, www.buckdaddys.com,

has been shut down.

______________________________

 

See if your County is

under a Burn Ban

 

Burn Ban Map

(click here)

 

NEW FOR YOUR VIEWING PLEASURE.  Slideshow!

Great Members, Great Land, Great Wildlife and Great Times!  See for yourself!

 

 

(click square on right to get full screen)

and for those in the country - if it keeps reloading, simply hit the pause button

for a minute while it gets ahead

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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I_WANT_TO_JOIN:
Name_New_Applicant: test from work
ReferringMember:
Contact_StreetAddress1:
Contact_Address6:
City1:
State1:
Zip:
County:
Contact_WorkPhone3:
Home_Phone:
Work_Phone:
Cell_Phone:
Email:
Referring_Member_if_applicable:
EmergencyName:
EmergencyPhone:
Insurance:
DL_No:
State:
License_Plates:
Total_No_In_Family:
Spouse_Name:
Child_1:
Child_2:
Child_3:
Child_4:
First_Choice:
Second_Choice:
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number:
Credit_card_number0:
Credit_card_number2:
Credit_card_number3:
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
Full_Pmt_650_Yes:
Renewal_Full_Pmt_Quantity:
Full_Pmt_Names:
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0:
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

What_R_U_Looking_for

Place_Me_With

AdditionalComments


WAIT_LIST:
I_WANT_TO_JOIN: x
Name_New_Applicant: test after removing forwarder
ReferringMember:
Contact_StreetAddress1:
Contact_Address6:
City1:
State1:
Zip:
County:
Contact_WorkPhone3:
Home_Phone:
Work_Phone:
Cell_Phone:
Email:
Referring_Member_if_applicable:
EmergencyName:
EmergencyPhone:
Insurance:
DL_No:
State:
License_Plates:
Total_No_In_Family:
Spouse_Name:
Child_1:
Child_2:
Child_3:
Child_4:
First_Choice:
Second_Choice:
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number:
Credit_card_number0:
Credit_card_number2:
Credit_card_number3:
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
Full_Pmt_650_Yes:
Renewal_Full_Pmt_Quantity:
Full_Pmt_Names:
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0:
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

What_R_U_Looking_for

Place_Me_With

AdditionalComments


Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: cc form blah
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
phone_number:
phone_number0:
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0:
fm_or_newapplicant_quantity0:
fm_or_newapplicant_name0:
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form:
Date of Credit Card Authorization:


WAIT_LIST: x
I_WANT_TO_JOIN:
Name_New_Applicant: Jose R. Zapata Jr.
ReferringMember: Josue Orellana
Contact_StreetAddress1: 2007 Basket
Contact_Address6: 2007 Basket
City1: Pasadena
State1: TX
Zip: 77502
County: Harris
Contact_WorkPhone3: Houston Heights High Scho
Home_Phone: 281-827-0814
Work_Phone: 713-868-9797
Cell_Phone: 281-827-0814
Email: mr.zapatin@gmail.com
Referring_Member_if_applicable: Cell/ text/email
EmergencyName: Yolizma Zapata
EmergencyPhone: 713-885-4000
Insurance: Blue Cross Blue Shield
DL_No: 15031031
State: Texas
License_Plates:
Total_No_In_Family: 4
Spouse_Name: Yolizma Zapata
Child_1: Sofia A. Zapata
Child_2: Jose R. Zapata III
Child_3:
Child_4:
First_Choice: 2100
Second_Choice:
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes: x
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 5152
Credit_card_number0: 3705
Credit_card_number2: 0286
Credit_card_number3: 0507
Credit_Card_Expiration: 11/17
three_digit_security_code: 508
Name_on_Card: Yolizma Z. Zapata
Billing_Address_on_card: 2007 Basket
City: Pasadena
state: Texas
zipcode: 77502
Full_Pmt_650_Yes: x
Renewal_Full_Pmt_Quantity: 1
Full_Pmt_Names: Jose Zapata Jr.
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0: Jose R. Zapata Jr.
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

My brother in laws .. Josue Orellana and Jose Luis Garcia.

What_R_U_Looking_for

I am looking for a hunting club that is family friendly and that is not too far from Houston.

Place_Me_With

I would to be placed in the 2100 property along with my brother-in-laws Josue Orellana and Jose Luis Garcia.

AdditionalComments

Thank you for your consideration.


WAIT_LIST:
I_WANT_TO_JOIN:
Name_New_Applicant:
ReferringMember:
Contact_StreetAddress1:
Contact_Address6:
City1:
State1:
Zip:
County:
Contact_WorkPhone3:
Home_Phone:
Work_Phone:
Cell_Phone:
Email:
Referring_Member_if_applicable:
EmergencyName: adsfadf
EmergencyPhone:
Insurance:
DL_No:
State:
License_Plates:
Total_No_In_Family:
Spouse_Name:
Child_1:
Child_2:
Child_3:
Child_4:
First_Choice:
Second_Choice:
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number:
Credit_card_number0:
Credit_card_number2:
Credit_card_number3:
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
Full_Pmt_650_Yes:
Renewal_Full_Pmt_Quantity:
Full_Pmt_Names:
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0:
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

What_R_U_Looking_for

Place_Me_With

AdditionalComments


WAIT_LIST:
I_WANT_TO_JOIN:
Name_New_Applicant: prayers for it to work
ReferringMember:
Contact_StreetAddress1:
Contact_Address6:
City1:
State1:
Zip:
County:
Contact_WorkPhone3:
Home_Phone:
Work_Phone:
Cell_Phone:
Email:
Referring_Member_if_applicable:
EmergencyName:
EmergencyPhone:
Insurance:
DL_No:
State:
License_Plates:
Total_No_In_Family:
Spouse_Name:
Child_1:
Child_2:
Child_3:
Child_4:
First_Choice:
Second_Choice:
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number:
Credit_card_number0:
Credit_card_number2:
Credit_card_number3:
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
Full_Pmt_650_Yes:
Renewal_Full_Pmt_Quantity:
Full_Pmt_Names:
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0:
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

What_R_U_Looking_for

Place_Me_With

AdditionalComments


Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: Prayers a 3rd time!
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
phone_number:
phone_number0:
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0:
fm_or_newapplicant_quantity0:
fm_or_newapplicant_name0:
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form:
Date of Credit Card Authorization:


WAIT_LIST:
I_WANT_TO_JOIN:
Name_New_Applicant: testewewe
ReferringMember:
Contact_StreetAddress1:
Contact_Address6:
City1:
State1:
Zip:
County:
Contact_WorkPhone3:
Home_Phone:
Work_Phone:
Cell_Phone:
Email:
Referring_Member_if_applicable:
EmergencyName:
EmergencyPhone:
Insurance:
DL_No:
State:
License_Plates:
Total_No_In_Family:
Spouse_Name:
Child_1:
Child_2:
Child_3:
Child_4:
First_Choice:
Second_Choice:
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number:
Credit_card_number0:
Credit_card_number2:
Credit_card_number3:
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
Full_Pmt_650_Yes:
Renewal_Full_Pmt_Quantity:
Full_Pmt_Names:
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0:
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

What_R_U_Looking_for

Place_Me_With

AdditionalComments


WAIT_LIST:
I_WANT_TO_JOIN:
Name_New_Applicant: one last time
ReferringMember:
Contact_StreetAddress1:
Contact_Address6:
City1:
State1:
Zip:
County:
Contact_WorkPhone3:
Home_Phone:
Work_Phone:
Cell_Phone:
Email:
Referring_Member_if_applicable:
EmergencyName:
EmergencyPhone:
Insurance:
DL_No:
State:
License_Plates:
Total_No_In_Family:
Spouse_Name:
Child_1:
Child_2:
Child_3:
Child_4:
First_Choice:
Second_Choice:
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number:
Credit_card_number0:
Credit_card_number2:
Credit_card_number3:
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
Full_Pmt_650_Yes:
Renewal_Full_Pmt_Quantity:
Full_Pmt_Names:
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0:
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

What_R_U_Looking_for

Place_Me_With

AdditionalComments


Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: test
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
phone_number:
phone_number0:
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0:
fm_or_newapplicant_quantity0:
fm_or_newapplicant_name0:
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form:
Date of Credit Card Authorization:


WAIT_LIST:
I_WANT_TO_JOIN:
Name_New_Applicant: alsdkjfa;sdjkf;adlskjf;aldskjfi0uer
ReferringMember:
Contact_StreetAddress1:
Contact_Address6:
City1:
State1:
Zip:
County:
Contact_WorkPhone3:
Home_Phone:
Work_Phone:
Cell_Phone:
Email:
Referring_Member_if_applicable:
EmergencyName:
EmergencyPhone:
Insurance:
DL_No:
State:
License_Plates:
Total_No_In_Family:
Spouse_Name:
Child_1:
Child_2:
Child_3:
Child_4:
First_Choice:
Second_Choice:
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number:
Credit_card_number0:
Credit_card_number2:
Credit_card_number3:
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
Full_Pmt_650_Yes:
Renewal_Full_Pmt_Quantity:
Full_Pmt_Names:
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0:
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

What_R_U_Looking_for

Place_Me_With

AdditionalComments


WAIT_LIST:
I_WANT_TO_JOIN:
Name_New_Applicant: Susan Witt
ReferringMember: TEST
Contact_StreetAddress1:
Contact_Address6:
City1:
State1:
Zip:
County:
Contact_WorkPhone3:
Home_Phone:
Work_Phone:
Cell_Phone:
Email:
Referring_Member_if_applicable:
EmergencyName:
EmergencyPhone:
Insurance:
DL_No:
State:
License_Plates:
Total_No_In_Family:
Spouse_Name:
Child_1:
Child_2:
Child_3:
Child_4:
First_Choice:
Second_Choice:
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number:
Credit_card_number0:
Credit_card_number2:
Credit_card_number3:
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
Full_Pmt_650_Yes:
Renewal_Full_Pmt_Quantity:
Full_Pmt_Names:
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0:
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

What_R_U_Looking_for

Place_Me_With

AdditionalComments


WAIT_LIST:
I_WANT_TO_JOIN:
Name_New_Applicant: Susan Witt
ReferringMember: TEST
Contact_StreetAddress1:
Contact_Address6:
City1:
State1:
Zip:
County:
Contact_WorkPhone3:
Home_Phone:
Work_Phone:
Cell_Phone:
Email:
Referring_Member_if_applicable:
EmergencyName:
EmergencyPhone:
Insurance:
DL_No:
State:
License_Plates:
Total_No_In_Family:
Spouse_Name:
Child_1:
Child_2:
Child_3:
Child_4:
First_Choice:
Second_Choice:
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number:
Credit_card_number0:
Credit_card_number2:
Credit_card_number3:
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
Full_Pmt_650_Yes:
Renewal_Full_Pmt_Quantity:
Full_Pmt_Names:
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0:
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

What_R_U_Looking_for

Place_Me_With

AdditionalComments


WAIT_LIST: x
I_WANT_TO_JOIN:
Name_New_Applicant: Todd Campbell
ReferringMember: Brandon Crackel
Contact_StreetAddress1: 2025 Ketch ct
Contact_Address6:
City1: Seabrook
State1: TX
Zip: 77586
County: harris
Contact_WorkPhone3: MemorialHermannLifeFlight
Home_Phone: 713 397 5336
Work_Phone:
Cell_Phone:
Email: todd.a.campbell1@gmail.com
Referring_Member_if_applicable: email
EmergencyName: Natasha Campbell
EmergencyPhone: 832 269 6814
Insurance: Tricare
DL_No: 34634024
State: TX
License_Plates: 8DVRDL.....
Total_No_In_Family: 4
Spouse_Name: Natasha Campbell
Child_1: Sophia
Child_2: Monty
Child_3:
Child_4:
First_Choice: 2100 Tyler co
Second_Choice: 1815
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes: x
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 4701
Credit_card_number0: 3203
Credit_card_number2: 0947
Credit_card_number3: 9026
Credit_Card_Expiration: 03/19
three_digit_security_code: 889
Name_on_Card: Todd A Campbell
Billing_Address_on_card: 2025 Ketch ct
City: Seabrook
state: TX
zipcode: 77586
Full_Pmt_650_Yes: x
Renewal_Full_Pmt_Quantity: 1
Full_Pmt_Names: Todd Campbell
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0: Todd Campbell
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

Co worker

What_R_U_Looking_for

Place_Me_With

Brandon Crackel, Donnie Beebe

AdditionalComments


WAIT_LIST:
I_WANT_TO_JOIN:
Name_New_Applicant: Jim Smylie
ReferringMember: Facebook
Contact_StreetAddress1: 193 Trahan Rd
Contact_Address6:
City1: Lumberton
State1: Texas
Zip: 77657
County: Hardin
Contact_WorkPhone3: Bell Engineering
Home_Phone: 409-755-4212
Work_Phone: 409-745-2877
Cell_Phone: 409-670-3332
Email: jwsmylie58@gmail.com
Referring_Member_if_applicable: email, text, cell
EmergencyName: Julie Smylie
EmergencyPhone: 409-670-7394
Insurance: Humana
DL_No: 02151060
State: Texas
License_Plates: AB2-0417 CHEVY TRUCK; GVM-7532 JEEP WRANGLER
Total_No_In_Family: 3
Spouse_Name: Julie Smylie
Child_1: Caitlin Smylie
Child_2:
Child_3:
Child_4:
First_Choice: tyler 2100
Second_Choice: sabine 428
YES_Leaving_Camper: x
Camper_Description: don't have one yet
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes: x
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 4147
Credit_card_number0: 8085
Credit_card_number2: 6861
Credit_card_number3: 8427
Credit_Card_Expiration: 04/18
three_digit_security_code: 236
Name_on_Card: JAMES W SMYLIE
Billing_Address_on_card: 193 Trahan Rd
City: Lumberton
state: Tx
zipcode: 77657
Full_Pmt_650_Yes: x
Renewal_Full_Pmt_Quantity: 3
Full_Pmt_Names: Jim Smylie, Julie Smylie, Caitlin Smylie
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0: James W. Smylie
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

Google search on Southeast Texas hunt clubs

What_R_U_Looking_for

I looking for a clean family experience. My 2 sons are grown and are both Eagle Scouts. My daughter deserves the same level of outdoor fun. Deer hunting is great, but year round is what I would like. Hog hunting looks like fun. I would like to try bow hunting.

Place_Me_With

Rev. Nathan Cohen (if a member), Rev. Steven Hays (if a member) I am getting the word out.

AdditionalComments


WAIT_LIST: x
I_WANT_TO_JOIN:
Name_New_Applicant: Joshua Durrance
ReferringMember:
Contact_StreetAddress1: 155 Lakeside Dr.
Contact_Address6: APT 5104
City1: Waxahachie
State1: Texas
Zip: 75165
County: Ellis
Contact_WorkPhone3: EMS USA inc.
Home_Phone:
Work_Phone:
Cell_Phone: 432-248-4423
Email: durrance_josh@yahoo.com
Referring_Member_if_applicable: Cell
EmergencyName: Nicole Durrance
EmergencyPhone: 479-883-4327
Insurance: Aetna
DL_No: 17062208
State: Texas
License_Plates: BEATAU
Total_No_In_Family: 2
Spouse_Name: Nicole Durrance
Child_1:
Child_2:
Child_3:
Child_4:
First_Choice: 428
Second_Choice: 2100
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes: x
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 5178
Credit_card_number0: 0598
Credit_card_number2: 2473
Credit_card_number3: 6095
Credit_Card_Expiration: 04/16
three_digit_security_code: 426
Name_on_Card: Joshua Durrance
Billing_Address_on_card: 155 Lakeside Dr. APT 5104
City: Waxahachie
state: Texas
zipcode: 75165
Full_Pmt_650_Yes: x
Renewal_Full_Pmt_Quantity: 1
Full_Pmt_Names: Joshua Durrance, Nicole Durrance
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0: Joshua Durrance
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

google

What_R_U_Looking_for

I am looking for a safe place to hunt with members who are management minded and fun to be around. I like the versatility of being able to deer hunt, duck hunt and pig hunt over the summers and in the off season.

Place_Me_With

AdditionalComments


WAIT_LIST:
I_WANT_TO_JOIN:
Name_New_Applicant: Jack. Sellers
ReferringMember:
Contact_StreetAddress1: 690 Bronson rd
Contact_Address6:
City1: Bronson
State1: Texas
Zip: 75930
County: Sabine
Contact_WorkPhone3: Retired
Home_Phone: 9367760515
Work_Phone: 9367760515
Cell_Phone: 9367760515
Email:
Referring_Member_if_applicable: Phone
EmergencyName: Pam sellers
EmergencyPhone: 9367761627
Insurance: United
DL_No:
State: Texas
License_Plates:
Total_No_In_Family: One
Spouse_Name: Pam
Child_1: O
Child_2: O
Child_3: O
Child_4: O
First_Choice: Bronson
Second_Choice: 0
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number:
Credit_card_number0:
Credit_card_number2:
Credit_card_number3:
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
Full_Pmt_650_Yes:
Renewal_Full_Pmt_Quantity:
Full_Pmt_Names:
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0:
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

What_R_U_Looking_for

Place_Me_With

AdditionalComments


WAIT_LIST:
I_WANT_TO_JOIN: x
Name_New_Applicant: alton berg
ReferringMember: john minkert
Contact_StreetAddress1: 125 east peach street
Contact_Address6: po box 2238
City1: angleton
State1: texas
Zip: 77515
County: brazoria
Contact_WorkPhone3: zackery
Home_Phone: 979-997-0683
Work_Phone:
Cell_Phone: 979-997-0683
Email: hunter321977@live.com
Referring_Member_if_applicable: 979-997-0683
EmergencyName: crystal berg
EmergencyPhone: 979-997-0687
Insurance: blue cross
DL_No: 04350120
State: texas
License_Plates: dkd0152, bd83582
Total_No_In_Family: 3
Spouse_Name: crystal berg
Child_1: paige berg
Child_2:
Child_3:
Child_4:
First_Choice: 1815
Second_Choice: 1815
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes: x
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 4476
Credit_card_number0: 6912
Credit_card_number2: 4757
Credit_card_number3: 1816
Credit_Card_Expiration: 04/16
three_digit_security_code: 274
Name_on_Card: crystal l berg
Billing_Address_on_card: po box 2238
City: angleton
state: texas
zipcode: 77516
Full_Pmt_650_Yes: x
Renewal_Full_Pmt_Quantity: 3
Full_Pmt_Names: alton berg, crystal berg, paige berg
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0: alton berg
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

from a friend john minkert

What_R_U_Looking_for

a place to take my family hunting and spend time together outdoors.

Place_Me_With

john minkert

AdditionalComments


WAIT_LIST:
I_WANT_TO_JOIN:
Name_New_Applicant: Jack sellers
ReferringMember:
Contact_StreetAddress1: 690 Bronson rd
Contact_Address6:
City1: Bronson
State1: Tx
Zip: 75930
County: Sabine
Contact_WorkPhone3: Clean harbors
Home_Phone: 9367760515
Work_Phone:
Cell_Phone: 9367761627
Email:
Referring_Member_if_applicable:
EmergencyName: Pam sellers
EmergencyPhone: 9367761627
Insurance: Blue cross
DL_No: 08168101
State: Tx
License_Plates: Czj8838. Ca55931
Total_No_In_Family: 2
Spouse_Name: Pam
Child_1: 0
Child_2: 0
Child_3: 0
Child_4: 0
First_Choice: Bronson
Second_Choice:
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes:
Visa_yes: x
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 4157
Credit_card_number0: 2615
Credit_card_number2: 0188
Credit_card_number3: 1933
Credit_Card_Expiration: 10/2018
three_digit_security_code: 465
Name_on_Card: Jackie b sellers
Billing_Address_on_card: 690 Bronson rd
City: Bronson
state: Tx
zipcode: 75930
Full_Pmt_650_Yes: x
Renewal_Full_Pmt_Quantity: 1
Full_Pmt_Names: Jack and Pam sellers
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0: Jack sellers
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

What_R_U_Looking_for

Place_Me_With

AdditionalComments


Mastercard_yes:
Visa_yes: x
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 4092598631866724
Credit_Card_Expiration: 07/18
three_digit_security_code: 234
Name_on_Card: Nathan W Hampton
Billing_Address_on_card: 701 Pridmore St.
City: Kaufman
state: Texas
zipcode: 75142
phone_number: 214-502-2556
phone_number0: nhampton@larrettinc.com
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0: x
fm_or_newapplicant_quantity0: 1
fm_or_newapplicant_name0: Nathan Hampton
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form: Nathan Hampton
Date of Credit Card Authorization: 1/25/16


Mastercard_yes:
Visa_yes: x
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 4120614063160167
Credit_Card_Expiration: 09/20
three_digit_security_code: 729
Name_on_Card: Devin S White
Billing_Address_on_card: 1021 Freeman Cemetery
City: Lufkin
state: Texas
zipcode: 75904
phone_number: 936 229-1823
phone_number0: ranch_dk@yahoo.com
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0: x
fm_or_newapplicant_quantity0: 1
fm_or_newapplicant_name0: Devin White
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form: Devin White
Date of Credit Card Authorization: 01/26/2016


WAIT_LIST: x
I_WANT_TO_JOIN:
Name_New_Applicant: Paxton O'Dell
ReferringMember:
Contact_StreetAddress1: 5505 chinkapin lane
Contact_Address6:
City1: Keller
State1: TX
Zip: 76244
County: Tarrant
Contact_WorkPhone3: 1st American Pymt Sys
Home_Phone: 8179051570
Work_Phone: 8179051570
Cell_Phone: 8179051570
Email: kkpacfaldal@gmail.com
Referring_Member_if_applicable: any
EmergencyName: Karen O'Dell
EmergencyPhone: 6828888441
Insurance: Geiko
DL_No: 29215586
State: Texas
License_Plates: DZK0400
Total_No_In_Family: 4
Spouse_Name: Karen O'Dell
Child_1: Fallon O'Dell
Child_2: Dalton O'Dell
Child_3:
Child_4:
First_Choice: Nacogdoches County
Second_Choice: Shelby County
YES_Leaving_Camper: x
Camper_Description: Will be purchasing and will provide description at that time
YES_Leaving_Camper0:
Mastercard_yes: x
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 5275
Credit_card_number0: 1500
Credit_card_number2: 7196
Credit_card_number3: 0181
Credit_Card_Expiration: 08/2018
three_digit_security_code: 299
Name_on_Card: Paxton O'Dell
Billing_Address_on_card: 5505 chinkapin lane
City: Keller
state: TX
zipcode: 76244
Full_Pmt_650_Yes: x
Renewal_Full_Pmt_Quantity: 1
Full_Pmt_Names: Paxton O'Dell
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0: Paxton O'Dell
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

internet

What_R_U_Looking_for

Family friendly is a HUGE factor. Also the ability to develop and hunt and area of my choosing.

Place_Me_With

Ryan Bear

AdditionalComments

The Above mentioned is submitting new application today as well and we would like to be assigned to the same property. thanks


WAIT_LIST: x
I_WANT_TO_JOIN:
Name_New_Applicant: Ryan Bear
ReferringMember:
Contact_StreetAddress1: 10365 BRADSHAW DR
Contact_Address6:
City1: FORT WORTH
State1: TX - Texas
Zip: 76108
County: TARRANT
Contact_WorkPhone3: First American Payment Sy
Home_Phone:
Work_Phone: 817-317-9123
Cell_Phone: 817-919-0557
Email: jhawkbear@gmail.com
Referring_Member_if_applicable: email or text
EmergencyName: Gillian Bear
EmergencyPhone: 817-797-9365
Insurance: Blue Cross Blue Shield
DL_No: 05608363
State: TX
License_Plates: BYL2015 and DL5S637
Total_No_In_Family: 3
Spouse_Name: Gillian Bear
Child_1: Mason Bear
Child_2:
Child_3:
Child_4:
First_Choice: nacogdoches
Second_Choice: shelby
YES_Leaving_Camper:
Camper_Description:
YES_Leaving_Camper0:
Mastercard_yes: x
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 5459
Credit_card_number0: 7700
Credit_card_number2: 0110
Credit_card_number3: 1800
Credit_Card_Expiration: 03/17
three_digit_security_code: 105
Name_on_Card: Ryan Bear
Billing_Address_on_card: 10365 BRADSHAW DR
City: FORT WORTH
state: TX
zipcode: 76108
Full_Pmt_650_Yes: x
Renewal_Full_Pmt_Quantity: 1
Full_Pmt_Names: Ryan Bear
Camper_Fee_Yes:
Renewal_Full_Pmt_Quantity0:
Full_Pmt_Names0:
Check:
Name_New_Applicant0: Ryan Bear
I_Agree_To_Bylaws_By_Submitting: Submit Form

Heard_From_Where

Online

What_R_U_Looking_for

A place with like-minded hunters and a place to enjoy with my family.

Place_Me_With

Paxton Odell

AdditionalComments

Please do not run my card without contacting me first. I will need to contact my bank to allow this size of transaction prior to the transaction.


Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 1234
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
phone_number:
phone_number0:
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0:
fm_or_newapplicant_quantity0:
fm_or_newapplicant_name0:
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form:
Date of Credit Card Authorization:


Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: tes9
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card:
City:
state:
zipcode:
phone_number:
phone_number0:
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0:
fm_or_newapplicant_quantity0:
fm_or_newapplicant_name0:
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form:
Date of Credit Card Authorization:


Mastercard_yes:
Visa_yes: x
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 4040140002017513
Credit_Card_Expiration: 05/2017
three_digit_security_code: 674
Name_on_Card: John Bown
Billing_Address_on_card: 410 N Casa Grande Cir
City: Duncanville
state: TX
zipcode: 75116
phone_number: 214-883-8400
phone_number0: jbownjr@yahoo.com
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0: x
fm_or_newapplicant_quantity0: 1
fm_or_newapplicant_name0: John Bown
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form: John Bown
Date of Credit Card Authorization: 01/30/16


Mastercard_yes:
Visa_yes: x
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 9266841288373473
Credit_Card_Expiration: 4/18
three_digit_security_code: 701
Name_on_Card: Victor Vega
Billing_Address_on_card: 5-19 Oviedo St. Urb. Torrimar
City: Guaynabo
state: Puerto Rico
zipcode: 00966
phone_number: 787-599-8342
phone_number0: vicveri2@yahoo.com
fm_or_newapplicant_paymentinfull_yes: x
fm_or_newapplicant_quantity: 870.00
fm_or_newapplicant_name: Victor Vega
fm_or_newapplicant_paymentinfull_yes0:
fm_or_newapplicant_quantity0:
fm_or_newapplicant_name0:
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form: Victor Vega
Date of Credit Card Authorization: Jan. 31, 2016


Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number:
Credit_Card_Expiration:
three_digit_security_code:
Name_on_Card:
Billing_Address_on_card: 8001 e elm
City: Houston
state: TX
zipcode: 77012
phone_number: 7134087621
phone_number0:
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0: x
fm_or_newapplicant_quantity0: 1
fm_or_newapplicant_name0: Daniel deleon
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form: Daniel Deleon
Date of Credit Card Authorization:


Mastercard_yes:
Visa_yes:
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 4342580948068168
Credit_Card_Expiration: 04/18
three_digit_security_code: 779
Name_on_Card: Daniel deleon
Billing_Address_on_card: 8001 e elm
City: Houston
state: TX
zipcode: 77012
phone_number: 7134087621
phone_number0: Ddeleon58@yahoo.com
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0: x
fm_or_newapplicant_quantity0: 1
fm_or_newapplicant_name0: Daniel deleon
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form: Daniel Deleon
Date of Credit Card Authorization: 2/2/16


Mastercard_yes:
Visa_yes: x
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 4092598633129881
Credit_Card_Expiration: 02/16
three_digit_security_code: 160
Name_on_Card: Richard T Boidy
Billing_Address_on_card: 430 oak leaf trail
City: Point
state: Tx
zipcode: 75472
phone_number: 2146688531
phone_number0: tyler.boidy@entechsales.c
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0:
fm_or_newapplicant_quantity0:
fm_or_newapplicant_name0:
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount: x
cm - other - quantity: 1
cm - other dollar amount: 770.00
cm - other - membername: Richard Tyler Boidy
cm - other - currentproperty: 1815
cm - other - comments : This is the remaining amount that I owe for the membership and camp fee
Authorized_Person_Submitting_Form: Tyler Boidy
Date of Credit Card Authorization: 02/05/2016


Mastercard_yes:
Visa_yes: x
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 4054182684113916
Credit_Card_Expiration: 01/18
three_digit_security_code: 500
Name_on_Card: Marty Branon
Billing_Address_on_card: 1219 Laredo Ln.
City: Mesquite
state: TX
zipcode: 75150
phone_number: 9728778468
phone_number0: marty@martybrandon.com
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0: x
fm_or_newapplicant_quantity0:
fm_or_newapplicant_name0: Marty Brandon
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form: marty brandon
Date of Credit Card Authorization: 2/6/16


Mastercard_yes:
Visa_yes: x
AmEx_yes:
DinersClub_yes:
DinersClub_yes0:
Credit_card_number: 4342580948068168
Credit_Card_Expiration: 4/16
three_digit_security_code: 779
Name_on_Card: daniel deleon
Billing_Address_on_card: 8001 e elm
City: HOUSTON
state: texas
zipcode: 77012
phone_number: 928 3625
phone_number0: ddeleon58@yahoo.com
fm_or_newapplicant_paymentinfull_yes:
fm_or_newapplicant_quantity:
fm_or_newapplicant_name:
fm_or_newapplicant_paymentinfull_yes0: x
fm_or_newapplicant_quantity0: 1
fm_or_newapplicant_name0: daniel deleon
fm_or_newapplicant_paymentinfull_yes1:
fm_or_newapplicant_quantity1:
fm_or_newapplicant_name1:
cmbalanceyes:
cmbalance_quantity:
cmdeposit_membername0:
sponsoredguestmembership_yes:
sm_quantity:
sm_sponsoringmembername:
sm_guestname:
sm_dateofvisit:
LQ_yes:
LQ_quantity:
LQ_membername:
LQ_membernumber:
Opt_Out_Fee_Yes:
Opt_Out_Fee_Quantity:
opt_out_fee_name:
CM - Other Amount:
cm - other - quantity:
cm - other dollar amount:
cm - other - membername:
cm - other - currentproperty:
cm - other - comments :
Authorized_Person_Submitting_Form: daniel deleon
Date of Credit Card Authorization: 2/6/16


Josue Orellana
6922 Elmscott Drive

Pasadena, Pasadena
Texas
77505
harris



713-232-0636

2010
Yonia Pulido
281-995-8830



3
Yonia Pulido
Victor Pulido
Sebastian Pulido


x
2100




x




5275
1500
7349
8990
07/19
440
Josue A. Orellana
6922 Elmscott Drive
Texas
77505






x
1
Josue Orellana







Submit Form


Scott Adkins
2907 Misty Way

Wylie, Wylie
Texas, Texas
75098
Rockwall
Walls Printing
9727950393
9727950393
9727950393
sc1o6tt@yahoo.com
2015
Carla Nichols


09882892

2
Carla Nichols




x
Shelby County





x



4610
4610
3117
7299
11/18
168
Sctt A. Adkins
2907 Misty Way
Texas
75098
x
1














Submit Form


Tim Mancill
13014 Foxburo

Houston, Houston
TX
77065





twm424@hotmail.com






2
Vicki Mancill





1400


x





x
6011
0047
3860
2669
05/20
341
Timothy Mancill
13014 Foxburo
TX
77065






x
100.00
Tim Mancill
x
150.00
Tim Mancill




Submit Form


Spencer Mancill
2200 33rd Street

Galveston, Galveston
Texas, Texas
77550
Galveston
Marathon Petroleum
409-762-0252
409-943-7587
409-771-6289
smancill @marathonpetroleum.com
2011 then 2013 till prese
Malyssa Mancill
409-893-7655
Blue Cross and Blue Shield
13618320
FFT-4423
2
Malyssa Mancill




x
1400


x
I stay in same trailer as Tim Mancill

x



4266
9020
2927
7140
12/18
191
Spencer W Mancill
2200 33rd Street
Texas
77550
x
1
Spencer Mancill






x
1
Just after curve on left road to back of camp 1st camper on right side




Submit Form


Michael Scott
9150 cr 4346

Larue
Tx
75770
Henderson
Self / Billy McManus roof
None
9032866303


2014
















































Submit Form


LUBOS POLACEK
6315 Central City Blvd. #213

Galveston
Texas, Texas
77551
USA

409-599-9792
409-599-9792
409-599-9792
L_Poldi@hotmail.com
2013




FLT 6762
1





x
#150



















x
1
720.00









x
1

x
Submit Form


LUBOS POLACEK
6315 Central City Blvd. #213

Galveston
Texas
77551
USA

409-599-9792
409-599-9792
409-599-9792
L_Poldi@hotmail.com
2013





1





x
#150



















x
1
720.00









x
1

x
Submit Form


Gill
6501 Shady Ln

Scurry , scurry
TX, tx
75158
Kaufman
Dallas ISD
9032461043
9725024700
9032461043
cgn_008@yahoo.com
2015
katie nelson
2148031381
aetna
00590151

3
Katie
Mary Kate Nelson



x
1815




x




5211
3400
1551
6309
09/18
551
cody g nelson
6501 Shady Ln
TX
75158






x
1
Gill Nelson







Submit Form


Bobby Lewis
14966 Saline Cr

Bullard , Bullard
Tx, Tx
75757
Smith
Arabian drilling
903 316 6332


lewisbobby3@gmail.com
2016
Brooke Lewis
903 316 7709

18336867
BK3 4952
5
Brooke
Lane 15
Kade 12
Cooper 10

x



x
Black gooseneck
x




5465
2800
2722
8126
4/16
988
Bobby L Lewis
14966 Saline Cr
Tx
75757






x
100
Bobby L Lewis







Submit Form


Chris Buhrow
7311 Maple Walk Dr.

Humble
TX, TX
77346
Harris
FEAM
832-656-9808
281-702-8120
832-656-9808
Chris.Buhrow@sbcglobal.net
2015
Angela Buhrow
832-883-6313
BCBS
11537994

1





x
556


































x
Submit Form


Todd Cofer
425 Rayford Rd
Apt 1322
Spring, Spring
TX, TX
77386
USA
Spirit Airlines


832-439-1112
tcofer72@yahoo.com
2015
Michelle Cofer
832-509-7452
United Health
05360496

3
Michelle Cofer
Madison Cofer



x
550





x



4663
0900
9413
0722
01/18
780
Todd M Cofer
425 Rayford Rd Apt 1322
TX
77386






x
1
Todd Cofer







Submit Form


Derrick White
10173 CR 400

Brazoria, Brazoria
Texas, Texas
77422
Brazoria
City of Angleton Police D
979-798-8767
979-849-2383 ext 3149
979-799-8089
easttexasman@gmail.com
2015
Karen White
979-799-7723
United Health Care
02156457
CNZ0882
5
Karen White
Damian Wollam
Kayla White
Madison White

x






x



4554
7500
0010
2089
01/19
383
Derrick J White
10173 CR 400
Texas
77422



x


x
1
Derrick J White







Submit Form


Mike Marcus
8114 Luna Drive

Rowlett
Texas, Tx
75088
Dallas
Atlas Copco Compresors LL
972-475-7435
NA
469-371-3606
mike.marcus@us.atlascopco.com
2000 I think
Holly Marcus
469-358=8965
BC/BC
13060444
Will advise
3
Holly Marcus
Tristin Marcus



x
Shelby County



28 Ft Terry


















x
1
Mike Marcus



x
1
Front by DPS Tower/Mailbox



x
Submit Form


Kris Rosenkoetter
3102 Cove View Blvd Apt. C201

Galveston, Galveston
Texas, Texas
77554
Galveston
Parallon
9792361912

9792361912
krosenko@gmail.com
2015
Diane Ragsdale
9792926974
VA
00801635
FYW7638
1





x
2100





x



4403
4806
0159
1380
01/17
865
Kristopher Rosenkoetter
3102 Cove View Blvd Apt. C201
Texas
77554






x
1
Kris Rosenkoetter







Submit Form


Timothy Goins
115 Anchusa Street

Lake Jackson
Texas, Texas
77566
Brazoria
BASF Corporation
979-285-0823
979-415-6690
979-373-8823
goins.tim@gmail.com
2011
Rebecca Goins
979-373-8825
BCBS
00780916

4
Rebecca Goins
Jenna Goins
Lexins


x
2100

























x
1
Timothy Goins







Submit Form


Dennis Ellis
2 Yuma Ln

Morgans Point Resort
TX-Texas, Arkansas
76513
Bell
US ARMY
5804834554
5804834554
5804834554
skydiver8it@yahoo.com
2015
Pamela Ellis
5804834554
Progressive
903866505
DV J4T8
4
Pamela Ellis
Whitney Ellis
Madison Ellis


x
1815



2008 Outback Toyhauler















x
1
Dennis Ellis












x
Submit Form


John Boyd
8805 woodglen dr

Rowlett , Forney
Tx, Tx
75088
Rockwall tx
Entech sales and service

9727508253

John.boyd11@outlook.com
2015
Amber Farquhar
9726723175
United health
53050574
1
1





x





x




5109
8204
2147
0923
03/17
108
John Boyd
118 stone st
Tx
75126






x

Brad Boyd







Submit Form


John Boyd
8805 woodglen dr

Rowlett , Forney
Tx, Tx
75088
Rockwall tx
Entech sales and service

9727508253

John.boyd11@outlook.com
2015
Amber Farquhar
9726723175
United health
53050574
1
1





x





x




5109
8204
2147
0923
03/17
108
John Boyd
118 stone st
Tx
75126






x

Brad Boyd







Submit Form


John Boyd
8805 woodglen dr

Rowlett , Forney
Tx, Tx
75088
Rockwall tx
Entech sales and service

9727508253

John.boyd11@outlook.com
2015
Amber Farquhar
9726723175
United health
53050574
1
1





x





x




5109
8204
2147
0923
03/17
108
John Boyd
118 stone st
Tx
75126






x

Brad Boyd







Submit Form


garrett deisher
816 akers

angleton, Angleton
TX - Texas, TX - Texas
77515
brazoria
zachry cont.
979-248-1378
same
same
garrettdeisher@yahoo.com
2014
shelly deisher
9792481147
Blue cross blue shield
34029017
DKD0636
3
Brittani
exzavier



x
2100



staying with my DAD.












816 Akers St


















Submit Form


garrett deisher
816 akers



























































Submit Form































































Submit Form


Tyler Boidy
430 oak leaf trail

Point, Point
Tx, Tx
75472
Rains
Entech Sales and Service

2142028855
2146688531
tyler.boidy@entechsales.com
2015
Roni Boidy
6183154382
Allstate
24646942
DJV4917
3
Roni Boidy
Waylon Boidy



x
1815


x
1986 prowler

x



4092
5986
3312
9881
02/16
160
Richard T Boidy
430 oak leaf trail
Tx
75472






x
1
Tyler Boidy







Submit Form































































Submit Form































































Submit Form


Desmonde Brushette
2051 State Hwy 31 E

Athens, Athens
TX, TX - Texas
75751
HENDERSON
9032867973
9032867973
9032867973
903 286 7476
des.56@hotmail.com
2007
Karen
9032867973
etmc healthfirst
1682269







x
1400





x



4790200090048739



01/17
872
desmonde brushette
2051 State Hwy 31 E
TX - Texas
75751






x
200.00
desmonde brushette







Submit Form


Desmonde Brushette
2051 State Hwy 31 E

Athens, Athens
TX, TX - Texas
75751
HENDERSON
9032867973
9032867973
9032867973
903 286 7476
des.56@hotmail.com
2007
Karen
9032867973
etmc healthfirst
1682269







x
1400





x



4790
2000
9004
8739
01/17
872
desmonde brushette
2051 State Hwy 31 E
TX - Texas
75751






x
200.00
desmonde brushette







Submit Form


Larry Whitus
883 cr 2351

Mineola
Texas, Texas
75773
Wood
NTMWD
9034977927
469-626-4957
9034977927
larrywhitus71@gmail.com
2013
Tina whitus
9034977763
United healthcare
07410563

3
Tina
Tory



x
1400


x
White portable





















x
1
Larry Whitus
x
1
By tower



x
Submit Form


Richard Clayton Reynolds
3326 Raleigh Place

Bossier, Bossier
Louisiana, MISSISSIPPI
71112
Bossier
6628032581
6628032581
6628032581
6628032581
rcreynoldsinms@gmail.com
2015
Kay Reynolds
6628032581
Blue cross blue shield
8005711069
WN6 225







1815









4630
9700
0094
2296
12/18
625
Richard c Reynolds
3326 Raleigh Place
Louisiana
71112
x
720
RICHARD CLAYTON REYNOLDS













Submit Form


Randy Douglas
2201 Jack Beaver Rd

Santa Fe, Spring
TX, TX
77517
Galveston
Douglas Field Service
843-797-3344
Same
Same
Randydouglad66@yahoo.com
2008
Tina Ekstorm
936697-8130

11666074

3
Tina Ekstrom
Kaitlyn Douglas



x
150





x



4427
4221
1582
1161
09/18
307
Randy Douglas
PO Box 7511
TX
77387






x
2
Randy Douglas and Jeremiah Callas







Submit Form


Randy Douglas
2201 Jack Beaver Rd

Santa Fe
TX
77517
Galveston
Douglas Field Service
843-797-3344
Same
Same
Randydouglad66@yahoo.com
2008
Tina A















































Submit Form


KENNY
2406 BRANDYSHIRE DR

KATY, KATY
TEXAS, TEXAS
77494
FORTBEND
REGAL NAILS
7133014187
7133014187

KENNYNGUYEN390@GMAIL.COM
2015
VAN DANG
8322176474
BLUECROSS BLUE SHIELD
4950046577

4
VAN DANG
DENNIS NGUYEN
TRISH NGUYEN


x






x



4147
7685
6911
7037
01/17
730
KENNY NGUYEN
2406 BRANDYSHIRE DR
TEXAS
77494
x















Submit Form


Bryan Lippe
21076 CR 2182

Whitehouse, Whitehouse
Texas, Texas
75791
Smith
Morton Salt


281-725-3504
bryan.lippe@gmail.com
2014
Donna Lippe
281-725-3507

11144859
CTY1114, DFM1886
3
Donna
Hannah




1440



30 ft fema trailer

x



4342
5800
8194
9828
12/19
811
Bryan Lippe
21076 CR 2182
Texas
75791






x
1
Bryan Lippe







Submit Form


Dennis Bingham
21447 Lindell Run Dr

Porter , Porter
Texas, Tx
77365
East Montgomery county
Otis Elevator
8323164137


Dennisbingham@hotmail.com
2013
Noreen Bingham
713 202 4445
Blue Cross
06639954
CND-3897
3
Candice Bingham
Dennis Bingham jr



x
2100




x




5594
0000
0411
2117
01/19
354
Dennis Bingham
21447 Lindell Run Dr
Tx
77365






x
1
Dennis Bingham







Submit Form


Dennis Bingham
21447 Lindell Run Dr

Porter , Porter
Texas, Tx
77365
East Montgomery county
Otis Elevator
8323164137


Dennisbingham@hotmail.com
2013
Noreen Bingham
713 202 4445
Blue Cross
06639954
CND-3897
3
Candice Bingham
Dennis Bingham jr



x
2100




x




5594
0000
0411
2117
01/19
354
Dennis Bingham
21447 Lindell Run Dr
Tx

















Submit Form


William a Day
550 cr 1977 lot 479

Yantis , Yantis
Texas, Texas
75497
Wood
Entech service and sails
2145858358
9727404810
2145858358
Archer.ncc.1701@gmail.com
2015
Chris hill
2144584727

05885364
03L CH7. GBK 828
0





x
Hemphill





x



4610
4609
3058
7365
05/18
850
William Andrew Day
550 cr 1977 lot 479
Tx
75497






x
100.00
William A Day







Submit Form


Andy Fuentes
4417 CR 651

Brazoria, Brazoria
Tx, Texas
77422
Brazoria
BASF Corp
979-798-0319
979-415-8389
979-480-2590
andres.fuentes@basf.com
2014
Cindy Fuentes
979-373-8994
United Healthcare
17044122

4
Cindy
Jonathan
Andrew
Jennie

x
2100





x



4476
6912
5627
3072
11/16
134
Andres Fuentes Jr
4417 Cr 651
Tx
77422






x
100.00
Andy Fuentes







Submit Form


Raul Figueroa
19055 bailey lane

Talty, forney
TX, TX
75126
Kaufman
Southwest Airlines
972-552-1341

816-665-4910
rrtfigueroa@att.net
2015
Robin Figueroa
816-520-8584
liberty mutual
34344100
CG7-R514 and BDJ-7417
4
Robin Figueroa
Taylor Figueroa
Cayla Dabney


x
2200



2005 fleetwood Bayside. Pop up Camper
x




5178
0584
2686
3968
06/2020
615
Raul A Figueroa
19055 Bailey Lane
TX
75126
x
1
Raul A Figueroa













Submit Form


Dennis Bingham
21447 Lindell Run Dr

Porter, Porter
Texas
77365
Montgomery
Otis elevator
8323164137

8323164137
Dennisbingham@hotmail.com
2013





3
Cadice Bingham
Dennis Bingham Jr



x
2100




x




5594
0000
0411
2117
01/19
354
Dennis Bingham
21447 Lindell Run dr
Texas
77365






x
1
Dennis Bingham







Submit Form


Joshua Nelson
238 Boone circle

East bernard, East Bernard
Tx, Tx
77435
Wharton
U.A plumbing local 68


979-888-8115
Jplumb79@me.com
2015
Jackie grace
832-918-1812
Blue cross
20587965

1
Jackie grace
Gage Kellum
Sarenidee Kellum


x
556



Pop up

x



4356
0300
7208
7173
01/20
123
Joshua Nelson
238 Boone circle
Tx
77435



x
1
I will make payment per our conversation over my Lawyor



x
1





Submit Form


Jose Amaya
2432 Calvin ave

Houston, Houston
Texas, Texas
77088
USA

281-448-7677
832-215-7922
281-726-1153
Josema0011@gmail.

Reyna Amaya
832-452-1614
Blue cross blue shield
15997854
AGO9387-- GJT2191-- FPR3039
5
Reyna Amaya
Regina Amaya
Jose Gael Amaya
Handel Amaya

x
#556 lease

N/A



x



4610
4609
3134
4741
06/18
574
Jose Amaya
2432 Calvin ave.
Texas
77088



x
1
Jose Amaya










Submit Form


test 8




























































Submit Form


test 3 - should be fixed




























































Submit Form




new tests






















































Submit Form




New test






















































Submit Form


c m schade
po b 850069

mesquite, mesquite
tx, tx
75185
dls
self
na
9722700600
9724898232
cmschade@cpctx.com
several
Nancy Tamayo
9728979287
medicare
10877410
same
1





x
with Super Tim


x
Same as last yr

x



5589
5500
4115
8363
02/19
802
c schade
pobox 850069
tx
75185
x
1
Doc













Submit Form


54567412321445414




























































Submit Form


54567412321445414




























































Submit Form


213212




























































Submit Form


213212




























































Submit Form


x
x
???






















































Submit Form


x
x
???






















































Submit Form




why is this not working






















































Submit Form




TEST






















































Submit Form