SICK/DEAD BAT REPORT

* Name:
Address1:
Address2:
* City:
State: Zip Code:
* Phone # - -
* E-mail:

* Number of Bats Found:
* Date of Observation: (mm/dd/yyyy)
* County of Observation Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha Kewaunee LaCrosse Lafayette Langlade Lincoln Manitowoc Marathon Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk Sauk Sawyer Shawano Sheboygan St. Croix Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood
* Description of Location:

Additional Comments: