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Mississippi Recreational Offshore Landing Permit Registration Form

First Name

Last Name

Suffix (Leave Blank if NA)

Date of Birth

Contact Phone Number

Enter your 10 digit phone number with no dashes or parenthesis

Email Address

MDWFP Customer ID #

Please enter in all leading zeros for 9-digit ID #

Check box if you are also a Mississippi licensed charter captain fishing for offshore species associated with the ROLP

Street Address

Address Line 2 (Apt. #, etc.)

City/Town

State/Province

ZIP/Postal Code

County

Do you wish to receive a

Digital card emailed to the above address

Digital card emailed and hard copy mailed to above address

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