Form 08-4010 - Master Guide License Application printable pdf download

GUI

State of Alaska

Department Use Only

Department of Community and Economic Development

Division of Occupational Licensing

Big Game Guide & Transporter Licensing Section

P.O. Box 110806, Juneau, Alaska 99811-0806

Telephone: (907) 465-2543/Fax: (907) 465-2974

E-mail: license@dced.state.ak.us

MASTER GUIDE LICENSE APPLICATION

Submit a complete, notarized or postmaster stamped application and appropriate

fees to the above address.

Resident: $150.00 ($50.00 nonrefundable application fee and $100.00 biennial license fee)

Nonresident: $250.00 ($50.00 nonrefundable application fee and $200.00 biennial license fee

Name:

Telephone:

Mailing Address:

City:

State:

Zip Code:

Date of Birth:

Social Security No.:

Sex:

Registered Guide License No.:

Unit(s) in which you are licensed to guide:

YES

1. Have you been convicted of a state hunting, guiding, or transportation services statute or

regulation within the last five years for which you were fined more than $1,000 or

imprisoned for more than five days?.....................................................................................

2. Have you been convicted of a felony within the last 10 years?............................................

3. Are your rights to obtain or exercise the privileges granted by a hunting, guiding, outfitting,

or transportation services license currently revoked or suspended in this state or another

state or in Canada?...............................................................................................................

Have you experienced or been treated for bipolar disorder, schizophrenia, paranoia, a

psychotic disorder, substance abuse, or any other mental or emotional illness which

may impair or interfere with your ability to practice as a Master Guide? ..............................

Have you been addicted to or excessively or illegally used alcohol or a controlled

substance? ............................................................................................................................

Have you experienced a physical disability which may impair or interfere with your ability

to practice as a Master Guide?..........................................................................................

If you answered “Yes” to any of the above questions, please explain dates and circumstances on a

separate piece of paper, and send any supporting documents that are applicable (court records, etc.)

08-4010 (Rev. 10/00)

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Form 08-4010 - Master Guide License Application