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Title
First Name
*
Last Name
*
Phone
*
999-999-9999
Email
*
Date and Time of Observation
*
Date and Time of Observation Date
Date and Time of Observation Hours
12 AM
1 AM
2 AM
3 AM
4 AM
5 AM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM
10 PM
11 PM
Date and Time of Observation Minutes
00
05
10
15
20
25
30
35
40
45
50
55
Location of Observation (be as specific as possible)
*
Did you catch or touch the hellbender?
*
No
Yes
If so, what did you do with it? (check all that apply)
Cut the fishing line
Removed the hook
Put it back where I found it
Called a resource professional (IDNR/Extension)
Threw it on the back
Killed it
Took it home alive
Other (please specify)
Other
Did you take a picture of the Hellbender?
*
No
Yes
May we follow up with to get more information?
*
No
Yes
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