Name: __________________________________

Mailing Address: _____________________________

Mailing City: ______________ State: __________ Zip: _____

Phone (Day) __________

Total Number in Group (Max 15): ___________________________

Total numbers and kind of livestock: __________________________________

____________________________________________________________________

_____________________________________________________________________

Our group will enter the Bridger Wilderness at:

_______________________________________ trailhead on

______________________________________________________

Our group will exit the Bridger Wilderness at:

_______________________________________ trailhead on

______________________________________________________

Print and fill out this form completely, then return to:

Pinedale Ranger District
29 East Fremont Lake Rd.
P.O. Box 220
Pinedale, Wy 82941
307-367-4326
Fax: 307-367-5750