Research Permit ApplicationPermit #

(Dec 2013 revision)

The Emiquon Preserve in Fulton County, Illinois, and the Merwin Preserve at Spunky Bottoms in Brown County, Illinois (Preserve(s)) are owned and managed by The Nature Conservancy (TNC), a non-profit corporation of the District of Columbia. TNC issues Research Permits atthesePreserve(s) to allow controlled access for scientific research.

In consideration of TNC permitting researchers to conduct research on the Preserve(s), the researcher states and agrees as follows:

  1. The holder of a Research Permit and all assistants are subject to and must abide by all rules and regulations identified on the Research Permit Application while conducting activities on the Preserve(s) and shall comply with all instructions or directions, either oral or written, from TNC.
  1. Applications must be emailed to , AND the original paper copy signed by the primary researcher must be received by TNC before a Research Permit will be granted. Application review may require up to 30 days.
  1. Research Permit holders are responsible for insuring any and all persons participating in, assisting with, and/or accompanying a researcher/assistant sign and submit the Research Liability Waiver portion of the Research Permit Application before they enter the Preserve(s). Permit holders are responsible for any and all actions of any and all assistants/participants while on the Preserve(s).
  1. Researchers/assistants will have a Research Permit with them while on the Preserve(s) and conduct their research in accordance with the approved Research Permit Application. The information summarized on the Application attached is incorporated into the Research Permit by reference. Modifications to an approved research project require advance written authorization from TNC.
  1. All Research Permits automatically terminate on 31 December 2014 unless terminated earlier by TNC.
  1. TNC reserves the right to terminate any Research Permit on TNC Preserve(s) at any time.
  1. By 15 January 2015, permit holders must submit an annual report to via email. This obligation shall survive termination of the Research Permit. Failure to submit an annual report may result in denial of future research permit requests. Reports must include:
  2. Names of Preserve(s) and date(s) visited.
  3. Numbers of specimens, species collected, and deposition by date and Preserve(s).
  4. A brief summary of project results.
  5. Copies of all publications derived from research allowed by the Research Permit.
  6. A list of all presentations/posters derived from research allowed by the Research Permit.
  1. TNC shall be acknowledged and given proper credit in all published papers and presentations relating to research or studies conducted on TNC Preserve(s). The acknowledgement will be in a form approved by TNC.
  1. Contact information, general description of research activities, and annual reports may be shared by TNC with other researchers and interested parties.
  1. Researchers/assistants shall not engage in any activities on TNC Preserve(s) that are unlawful, improper, or contrary to any applicable law, regulation, or ordinance.
  1. Researchers/assistants shall conduct themselves at all times in a manner that respects the site’s integrity as a nature preserve and shall take care to safeguard the condition of the property and the natural resources thereon.
  1. Researchers and their assistants may not collect, remove, disturb, harm, harass, take, or destroy any rocks, minerals, plants, artifacts, animals , specimens, or matter, nor parts thereof, except to the extent specifically authorized in writing by a Research Permit. Except as authorized by such permit, all research activities must be non-invasive. Even where collection or other invasive research activities are authorized, researchers and their assistants shall at all times minimize disturbance and shall cause no long-term impacts to natural communities or populations. Negative impacts associated with conducting research on TNC Preserve(s) shall also be minimized by proper use of vehicles and equipment. If TNC staff identifies negative impacts or wasteful practices that could affect the Preserve(s), researchers must cooperate with TNC staff to avoid or minimize the impacts.
  1. Researchers and/or assistants authorized by TNC to collect flora/fauna are required to possess all applicable local, state and federal collecting permits and authorizations. It is the responsibility of researchers to ascertain in advance and fully comply with the terms of any governmental permits and any federal, state, and local provisions that may apply to their planned activities, throughout their stay. Researchers need to submit copies of all permits and authorizations to TNC before any collections are made on the Preserve(s).
  1. Researchers/assistants should assume rarity when encountering any unfamiliar plant or animal and to seek specific guidance from TNC if a known species or community is rare or imperiled. Researchers/assistants shall take appropriate protective measures to ensure flora/fauna known or suspected to be rare or imperiled shall not be disturbed. Researchers/assistants are expected to collect conservatively and will be constrained to the kinds and numbers of specimens specifically authorized by this permit. Researchers/assistants are expected to collect in a discreet manner, away from roads, trails, and developed areas unless specified otherwise, and are required to minimize damage.
  1. All property (equipment, vehicles, etc.)brought onto the Preserve(s) by researchers/assistants shall be stored and used in manners that allow for continued use of the Preserve(s) by TNC and other visitors and that does not cause a nuisance or danger to others, nor create an unsightly condition. While on the Preserve(s), researchers shall conduct themselves so as not to threaten the health or safety of others and shall refrain from interfering with the quiet enjoyment of any other persons who may be on or near the Preserve(s).
  1. Researchers/assistants are legally responsible for their boat’s wake(s)(wave), and are liable for any damage(s) it causes, and must not endanger other boaters.
  1. Camping and fires are prohibited on the Preserve(s) without written authorization from TNC.
  1. Possession of weaponson the Preserve(s) is prohibitedwithoutwritten authorization from TNC.
  1. Alcoholic beverages are prohibited on the Preserve(s) without written authorization from TNC.
  1. Dogs are prohibited on the Preserve(s) beyond the office yard without written authorization from TNC.
  1. No substances, chemicals, materials, or wastes, may be brought, utilized, stored, processed, transported, disposed of, dumped, or released on, under, about, or from the Preserve(s) without written authorization from TNC.
  1. Researchers/assistants may not install or erect any permanent or temporary structures, fixtures or attachments on the Preserve(s) without written authorization from TNC.
  1. TNC reserves the right to remove research equipment on the Preserve(s).
  1. Researchers/assistants must be aware of TNCs’ property boundaries and avoid trespassing on private property adjacent to the Preserve(s).
  1. Researchers/assistantsmust obtain authorization from landowner(s) for access to lands or waters owned by a person or entity other than TNC.
  1. Access to the Preserve(s) must be along existing roads. There shall be no off-road vehicle use without written authorization from TNC.
  1. Water levels may fluctuate at any time due to natural causes and/or by TNC or others.
  1. TNC reserves the right to restrict access to any area of the Preserve(s) at any time for any reason. In such event, researchers/assistants shall not use such area(s) in any manner whatsoever. TNC also reserves the right to use, and to permit others to use, areas of the Preserve(s) that are being accessed by researchers/assistants. However, TNC will make reasonable efforts to avoid interfering with research projects.
  1. Various authorized waterfowl and deer hunting takes place on the preserve(s). Research Permit(s) may be further restricted by TNC due to hunting programs. You need to work with TNC ifresearch coincides with hunting season.

RESEARCHAPPLICATION

  1. Applicant’s Full Name:Click here to enter text.
  1. Affiliation:Click here to enter text. Position: Click here to enter text.
  1. Address:Click here to enter text. E-mail address:Click here to enter text.
  1. Office Phone:Click here to enter text. Cell Phone:Click here to enter text.
  1. General field of interest and professional qualifications:Click here to enter text.
  1. List all pertinent permits held:Click here to enter text.
  1. Is this a renewal? Type Yes or No If yes, you still must fill out this entire form. Please CAPITALIZE text that reflects any change(s) from last year.
  2. Project title (5 word limit): Click here to enter text.
  1. Name of preserve(s):Type Emiquon and or Spunky Bottoms.
  1. Time, Frequency, and length of visits and number in party: Click here to enter text.
  1. List name(s) and role(s) of other assistants/participants: Click here to enter text.
  1. Duration of project (with dates):Click here to enter text.
  1. General description of research including objective(s):Click here to enter text.
  1. List species and/or materials collected:Click here to enter text.
  1. Method of collection(s):Click here to enter text.
  1. Number of specimens and deposition:Click here to enter text.
  1. Other disturbances to be made:Click here to enter text.
  1. List records to be kept:Click here to enter text.
  1. Describe the kinds and amounts of any hazardous chemicals you need to bring onto the preserve(s) and disposal methods:Click here to enter text.
  1. Location(s) of research and access routes. Please be as specific as practical. A detailed description, GPS coordinates, a GIS shapefile, a KML file, and/or maps with the research site(s)/area(s) identified are all acceptable formats that can be submitted with the application.Click here to enter text.
  1. OTHER PERTINENT INFORMATION:Click here to enter text.

RESEARCHERAPPLICANT SIGNATURE: DATE:

THE NATURE CONSERVANCY APPROVAL: DATE: ______

Research Liability Waiver

This RESEARCH LIABILITY WAIVER is valid only in association with Research Permit # ______

held by ______(print name/affiliation of permitted researcher) for

researchat☐ Emiquon Preserveand/or ☐ Merwin Preserve (check one or both preserves,asapplicable).

The Nature Conservancy,a non-profit corporation of the District of Columbia, Research Permits to be conducted at the Illinois River Program Emiquon Preserve in Fulton County and/or the Merwin Preserve at Spunky Bottoms in Brown County.

Anyone entering the Preserve(s) must first completely fill out and file with TNC this RESEARCH LIABILITYWAIVER. Properly completed and signed waivers must be submitted to Sally McClure, The Nature Conservancy, 11304 N. Prairie Rd, Lewistown, IL 61542.

  1. I have read and understand, am subject to, and will abide by all rules and regulations identified on the Research Permit while assisting with research on the Preserve(s) and shall comply with all instructions or directions, either oral or written, from TNC.
  2. All research activities will be conducted in accordance with the Research Permit.
  3. I agree and acknowledge that TNC makes no warranties or representations, express or implied, and that I am engaging in activities at the Preserve(s) at my own risk.
  1. I understand the possible dangers that might be involved in the type of activities I will be participating in. I am aware of no problem or condition that could endanger others or myself if I or my researchers/assistants/participants participate in activities at the Preserve(s).
  1. I for myself and my heirs, hereby waive, release, indemnify, and hold harmless TNC and its officers, directors, and employees from any and all claims, liabilities, losses, damages, and expenses incurred in connection with my presence and activities on the Preserve(s) and the foregoing actions and circumstances resulting from any injury to me or damage to my property at the Preserve(s).
  1. I grant the Conservancy permission to take photographs, video, and audio representations of me while at the Preserve(s). I hereby irrevocably consent to and authorize the royalty free use and reproduction by the Conservancy, or anyone duly authorized by TNC, of any and all such photographs (including negatives) and video/audio representations for any legitimate purposes, including but not limited to advertising, trade and editorial purposes, at any time in the future in all media now known or hereafter developed, throughout the world. I also consent to the use of my name in connection with such photographs, video and audio representations and writings under the same terms. I hereby release, indemnify and hold harmless the Conservancy and its officers, directors, agents, and employees from any and all claims which may result at any time by reason of the use of my image, video and audio representations, writings and name, including, without limitation, claims of privacy. My heirs, executors, administrators, and assigns shall be bound by this consent and release.

BY SIGNING, I ACKNOWLEDGE I AM AT LEAST 18 YEARS OF AGE, OR IF NOT, THE SIGNATURE OF A PARENT OR GUARDIAN IS PROVIDED BELOW. I UNDERSTAND THE USE OF THIS PRESERVE(S) IS A PRIVILAGE GRANTED TO ME AND THIS PRIVILAGE MAY BE REVOKED AT ANY TIME. I CERTIFY I HAVE READ AND UNDERSTAND THE PERMIT REQUIREMENTS, CONDITIONS AND RULES, ABOVE, AND I WILL ADHERE TO THEM, AND THAT THE INFORMATION PROVIDED IN THIS DOCUMENT IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.

NAME (PRINTED): ______

TELEPHONE: ______EMAIL: ______

SIGNATURE:______DATE:______

PARENT OR GUARDIAN SIGNATURE FOR LISTED MINOR: DATE:

“This map is a visual representation of information in the possession of The Nature Conservancy. It is not a substitute for a legal survey or legal description. The Nature Conservancy disclaims any representations or warranties as to the accuracy, timeliness or completeness of maps or the underlying data on which the maps were derived.

  • In case of emergency, it is approximately 6 miles to the nearest hospital-Mason District Hospital in Havana a9 (309) 543-4431 or at 911.
  • To contact The Illinois Department of Natural Resources Conservation Police call the Fulton County Sheriff at (309) 547-2277.