Safari Club International Hunting Award Application Diana Award DIANA AWARD TM : Established in 1995, the Diana Award honors the female hunter. Named for the huntress of Roman mythology, it recognizes the women of SCI who have excelled in international big game hunting. Nominees will have shown exemplary ethics in the field, remained committed to the mission statement of SCI, and have personally given of their time and energies to enhance wildlife conservation and education. This award is sponsored by NRA Women s Leadership Forum. Nomination forms are posted on www.safariclub.org. Application deadline is September 1 of each award year. NAME: ADDRESS: CITY: STATE: ZIP: COUNTRY: TELEPHONE: FAX: Please complete the following: 1. Have you ever been adjudicated (convicted) or has adjudication been withheld for a misdemeanor or felony in a province, tribal, state or federal/national court for a game law violation? Yes No 2. Have you ever been adjudicated (convicted) or has adjudication been withheld for a misdemeanor or felony in a province, tribal, state or federal/national court for the possession or use of a weapon or firearm? Yes No 3. Have you ever been adjudicated (convicted) or has adjudication been withheld for a misdemeanor or felony in a province, tribal, state or federal/national court for a crime involving moral turpitude? Yes No If you answered yes to any of the preceding questions, please explain all of the circumstances pertaining thereto and submit all relevant documentation. 1. To the best of your knowledge, have you hunted all of the animals you have entered with SCI in accordance with all applicable laws? Yes No 2. Have you personally taken/harvested all of the animals you have entered with SCI? Yes No If you answered no to any of the preceding questions, please explain all of the circumstances pertaining thereto and submit all relevant documentation. I swear or affirm that the information given above and annexed hereto is accurate and complete to the best of my knowledge. SIGNATURE: DATE:
NOTE: The answers are subject to investigation by Safari Club International, its Ethics and Code of Conduct Committee and the Executive Committee. Please list all conservation accomplishments. (Please use additional sheets as necessary)
Please list all additional accomplishments of merit, special awards and related activities in the field of big game hunting. (Please use additional sheets as necessary)
SAFARI CLUB INTERNATIONAL HUNTING SUMMARY Number of major trophy hunts; please include the year and country involved. For significant unsuccessful hunts, please provide a brief description on the lines provided below. North America South America Africa # of hunts Location # of hunts Location # of hunts Location Europe South Pacific Asia # of hunts Location # of hunts Location # of hunts Location Please provide an account of significant unsuccessful hunts
SAFARI CLUB INTERNATIONAL HUNTING SUMMARY Complete the table below, indicating the number of hunts you have taken on each continent, and the number of countries in which you have hunted. In the species column, you should record all those species which are recognised for the purposes of the SCI record book and which you have submitted to SCI, whether as a record book or photo entry. In the Misc column, you should record any game species which cannot be measured for the record book and for which you have submitted a photo entry. You may identify on a continuation sheet any species for which you have not submitted a record book or photo entry, but the weight given to these is limited. North American countries include Canada, Mexico and Central America. Country # of hunts # of Countries # of species # of misc. # of top 20s # of top 10s # of Ones North America South America Africa Europe Asia South Pacific Exotics TOTAL SCI Service Record Chapter &/or SCI Committee Year(s) Served Position: Chairman, Vicechair, Sub-chair, Member
SAFARI CLUB INTERNATIONAL HUNTING AWARD WAIVER, RELEASE AND INDEMNITY AGREEMENT In consideration of my being permitted to receive, complete and submit this application and for me being considered and judged for either the Diana Award or the CJ McElroy Award or any other recognition by Safari Club International which such recognition shall include but not limited to all communication and or publicity and or inquiry involving any of the above I agree as follows: 1. I agree to indemnify, defend (by and through counsel acceptable to and approved by SCI) and hold harmless the Indemnities identified below from and against any and all claims of any and every nature whatsoever that may be asserted, claimed, instituted or recovered against any of the Indemnities arising out of or in any way connected with my participation or involvement in, or the completion or submission of the application or other information or materials by or relating to me in connection with, the consideration, evaluation, deliberation, materials by or relating to me in connection with, the consideration, evaluation, deliberation, judging, granting or withholding of the Safari Club International Hunting Award by or from SCI. As used herein, Indemnities means and includes SCI and all of its affiliated entities and their respective directors, officers, employees, agents, members, representatives, selection judges, volunteers and successors in interest, together with all persons and entities providing information, data or materials (whether or not true or accurate, substantiated or unsubstantiated) or providing any assistance to or for, or participating with, any of the foregoing in connection with the consideration, evaluation, deliberation, judging, granting or withholding of the Safari Club International Hunting Award by or from SCI. As used herein, claims means and includes all claims, demands suits, actions, litigation, arbitrations, mediations, investigations, losses, damages, liabilities, obligations and/or expenditures of any type whatsoever (including, without limitation, those based on or seeking to recover for monetary loss, libel, slander, defamation, loss of respect, or discrimination or unfair treatment because of or based on age, gender, national origin, sexual orientation and/or religious beliefs and those seeking injunctive or mandatory relief) arising from, as a result of or in connection with the consideration, evaluation, deliberation, judging, granting or withholding of the Safari Club International Hunting Award by SCI. 2. I acknowledge and agree that the criteria for the Safari Club International Hunting Award is subject to change and that there are subjective factors that are involved in determining who shall be entitled and permitted to receive, complete and submit applications therefore, and who shall receive, such awards. I hereby forever waive and relinquish, and agree never to make or assert, any and all claims that I might otherwise have with respect to each and every Indemnity. 3. All communications, transmittals and submissions from me to any and all Indemnities with respect to the Safari Club International Hunting Award and shall be in writing and I acknowledge that no consideration whatsoever will be given to any oral, visual, electronic or other non-written communications, transmittals, submittals or materials. I hereby acknowledge and confirm that neither I nor any agent, representative, broker, attorney or other person acting for or on my behalf has heretofore received or relied on, or hereafter will rely on, any actual or alleged representation, warranty, promise, inducement covenant, agreement or other In consideration of my being permitted to receive, complete and submit this application and for me being considered and judged for either The Diana Award or the C.J. McElroy Award or any other recognition by Safari Club International which such recognition shall include but not limited to all communication and or publicity and or inquiry involving any of the above I agree as follows: assurance of any kind or nature whatsoever by, from or on the part of SCI or any of the other Indemnities with respect to the Safari Club International Hunting Award except as specifically set forth in the application for such award or in a written document issued by SCI. 4. I agree that this Indemnity, Waiver and Release shall be interpreted and construed in accordance with the fair and reasonable meaning of the provisions hereof for the purpose of effectuating the purpose and intent hereof and that no rule of law which would otherwise apply in connection with the interpretation and construction of this Indemnity shall be applied in interpreting and construing the Indemnity including, without limitation, any rule of law to the effect that conflicting, ambiguous or inconsistent provisions contained herein shall be interpreted or construed in favor of or against me or any of the Indemnities. If any provision of this Indemnity is determined to
be unenforceable or invalid by any court or other tribunal or arbitrator with jurisdiction, then such provision shall be severed from this unenforceable or invalid provision had never been contained herein. 5. I agree that this Indemnity shall be interpreted, construed and enforced in accordance with the laws of the State of Arizona, United States of America, without giving effect to principles of conflict of laws, and I hereby irrevocably submit myself to the jurisdiction of the Superior Court of Pima County, Arizona for the purposes of all litigation and judicial proceedings pertaining to any claim arising under or subject to this Indemnity, and I waive, and agree that I shall not assert, by way of motion, as a defense, or otherwise, any claim (i) that I am not personally subject to the jurisdiction of such court; (ii) that a suit, action or proceeding brought in such court is brought in an inconvenient forum; (iii) that the venue of a suit, action or proceeding brought in such a court is improper; or (iv) that this Indemnity may not be enforced in or by such Court. 6. I certify that I have never been convicted of, and am not now and never have been under investigation for, any violation of any game or wildlife law of any state, province or nation whatsoever. I acknowledge that a past conviction for, or being subject to a current investigation of or as to, any violation of any such game or wildlife law is sufficient grounds for disqualification of any person as a nominee for or recipient of the Safari Club International Hunting Award and that SCI s Ethics Committee may determine any person to be ineligible for any such award based upon actual, suspected or alleged violations of game and wildlife laws. 7. I have fully read this Indemnity and I understand its contents, whether or not my native language is English. If I am not able to adequately understand English, I have procured, paid for and am delivering herewith a certified translation of this Indemnity in my native language, which I have also signed. I have signed this Indemnity willingly and without duress of any type or sort whatsoever, and without relying on any oral or written representation or statement made by any person with reference to the subject matter hereof. I am also waiving and releasing all claims I have or might in the future have in connection with the consideration, deliberation, granting or withholding of any recognition, grant or award by SCI and that one of this Agreement s purposes, to which I agree, is to bar me from ever asserting and claim against any of the Indemnities in connection with the awarding or failure to award the Safari Club International Hunting Award and, in addition, that this Indemnity obligates me to indemnify, defend and hold harmless each Indemnity with respect to all such claims. 8. I have signed this Indemnity of my own free will, and with the intent to make and establish it as an obligation binding on myself, my heirs, executors, administrators, personal representative, successors, in interest and assigns both now and at all times in the future. Executed and witnessed on, 20 Printed Name: Signature: Address: Witnessed By: Printed Name: Signature: Address: