Wildlife Habitat Application Form

I wish to declare a nature habitat/wildlife garden. I have read the declaration and am happy with it. I agree to register my habitat with the National Wildlife Federation's Backyard Wildlife Habitat scheme, or equivalent outside the US (if such exists in my country). Signed
Full Name(s)
Street
Town
State or other admin division
Country
Phone
Email (please enter twice)
The area I wish to manage for wildlife is approximately
Location of land if not at my home (nearest village/town)
The major type(s) of habitat or vegetation is/are:-
Important animals residing or visiting
I am interested/ not interested in the following:-
Allowing access to groups	Educational Environmental Pantheist
Allowing access to individuals
Hosting pan gatherings
Hosting natural weddings and child namings
Having my reserve listed with photos in the WPMReserve pages (no addresses are provided, only the location as specified by you above)
Including my email so people can contact me about access