REGISTRATION FORM

4-H SHOOTING SPORTS WORKSHOP

Lake Cumberland 4-H Education Center, Jabez, KY

March 2 – 4, 2018

Name E-mail Address ______

 Agent  Volunteer  Teen Leader Age______** Gender______

Race*: Check all that apply:  American Indian  Asian  Black  Pacific Islander  White

Are you:  Hispanic  Non-Hispanic*to comply with affirmative action Civil Rights Standard

Address ______City______

County ______State _____ Zip ______H Phone ______Cell Ph ______

** In order to assure that counties have the certified leaders that their Shooting Sports programs need, teens will not be assigned to a class until all adults have been registered.

PLEASE CHECK:

Are you a First Time participant at a 4-H Shooting Sports Workshop in the state of Kentucky?

____Yes ____NO if not, please list previous Certification discipline(s).

Limits are placed on class sizes for the workshop. Since some classes fill faster than others, rank your preference for classes you would like to attend. (Please rank 1st, 2nd, 3rd etc.)

___Coordinator ($60)

___22 Rifle/Air Rifle ($60)

___22 Pistol/Air Pistol ($60)

___Black Powder ($60)

___Shotgun ($60)

______Archery ($60)

______Range Safety Officer ($ 40)

*Must be 21 years to sign up for this discipline*

*Not available to first time participants*

Training is two full days – Saturday and Sunday

______Hunter Challenge ($60)

After registering online, mail Registration Fee to:
By February 16, 2018 (Fee payment must be postmarked by this date)(Late registrations will not be accepted).
(4-H Agent must sign off on the screening process on the second page.) / Donna Fox
4-H Youth Development
212 Scovell Hall
Lexington, KY 40546-0064

4-H SHOOTING SPORTS FEES

March 2 – 4, 2018

Fill in those costs appropriate to your arrival and departure times. First time participants should arrive between from 6-7:00 p.m. on Friday evening. Classes will begin at 7:30 pm on the dot. If you are a returning participant you may arrive Friday evening, but your classes will not begin until 8:30 am on Saturday.

Registration fee is $60.00, EXCEPT for RSO, which is $40.00 and Hunter Ed if offered (free)

(Everyone will be required to room Double, Triple, or Quad...NO SINGLES!)

See Cancellation Policy Below

NAME______COUNTY ______

I wish to room with: ______

Please list/explain any allergies, dietary restrictions:

______

Registration is not complete until fees have been received.

MAKE CHECKS PAYABLE TO: Kentucky 4-H Foundation. Write Shooting Sports WORKSHOPon the memo line.

Cancellation Policy: For cancellations not made prior to the week of the workshop or for any no shows, the registration fees will not be refunded. Classes are scheduled on a first registered, first paid basis.

*Don’t forget about the Silent Auction. Proceeds benefit Shooting Sports Camp*