Materials Request Form - Virginia Department of Game and Inland ...

Virginia Department of Game and Inland Fisheries
Angling Education Program
Materials Request Form
The Department of Game and Inland Fisheries offers a variety of items to help make
your angling education program both instructive and fun. Virginia anglers pay for the
materials, instructional aids, and promotional items through the purchase of fishing
licenses. The materials are therefore provided free of charge to educators who are
licensed Virginia Anglers. For those who are not licensed anglers there is a nominal
charge for student materials.
To Request Materials For Your Fishing Education Program:
1. Your program must be conducted in Virginia.
2. Submit your request 30 days prior to event. (Recommended for on-time delivery)
3. Please submit a description of your program in the appropriate section of this form.
4. Select the materials you need for your program from the list provided.
5. If you do not have a current VA Freshwater Fishing License, calculate the cost of the
materials and include payment with order.
Calculating The Cost For Your Student Materials
1. If you have a Virginia freshwater fishing license for the year during which your
program is taking place there is no cost for your order of student materials. We do
however reserve the right to change your order based on the information in your
program description or product availability. Provide your license information below:
VA Freshwater Fishing License Number:
Purchase Date: (month/year)
2. If you do not have a current Virginia freshwater fishing license there is a 20-cent
charge for each item ordered from the student materials section. To calculate your
payment use the following equation: (make payment to Treasurer of VA)
Total Number of Student Items X 20 Cents per item = $
Provide Your Shipping (UPS) Address (No P.O. Boxes)
Please Print Clearly
Name:______________________________________________
Street Address:_______________________________________
City:_____________________________________________, VA
Zip Code: ______________
Phone Numbers: ( )______________ ( )______________
Email Address: _____________________________________________

Program Description
Name of Program:
Contact Person/Organization:
Phone: ( ) Email:
Program Date(s): _______________________________________________________
Type of Program: Clinic Camp Club Tournament Other ______________
Location: _______________________________ County/City ___________________
What are the ages of the participants ________ Attendance Expected: ____________
How many people are staffing the program _________
Brief program description: _________________________________________________
______________________________________________________________________
Materials Order Form
Write the quantity of each of the items you are requesting in the space provided. Choose items
that are age and topic appropriate. We reserve the right to change your order based on your
program description and product availability. Requests are continually coming in and are filled
based on your program date. Items typically ship 2 weeks before event date.
List Quantity
____ Fishing is Fun Pamphlet (ages 8-adult)
____ Freshwater Fishing Regulations
(Contains a Fish ID Guide)
____ Fishing Coloring Book (ages 8-10)
____ Freshwater Fish ID Poster - Small
____ Fishing Certificate of Participation
____ Clear Plastic Creel Bag
____ Temporary Tattoos
For Educational Sessions Only (Max 30)
____ Color-a-Fish Coloring Book (ages 6-10)
____ Fishing Fun for Kids Booklet (ages 6-8)
____ Sidekicks Go Fishing (ages 9-12)
These items are available in a limited number per
event:
____ Basic Angling Education Series
Curriculum CD ROM (max 1)
____Freshwater Fish ID Guide (max 25)
____ Bluegill Poster (max 5)
____ Largemouth Bass Poster (max 5)
____ Muskie Poster (max 5)
____ Macro Invertebrate Poster (max 5)
____ Fish/Forest Fires Poster (max 5)
____ Freshwater Fish ID Poster-Large (max 10)
____ Saltwater Fish ID Poster (max 5)
Email your Request or Questions to:
Meghann.Rothgeb@dgif.virginia.gov
Fax Your Request to:
Angling Ed/Materials Request
(804)-367-6179
Mail Your Request to:
Angling Ed/Materials Request
VA Department of Game & Inland Fisheries
4010 West Broad Street
Richmond, VA 23230