North Carolina 4-H Shooting Sports Workshop
April 11-13, 2008
Millstone 4-H Camp, Ellerbe, NC
Registration Form
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Return to:
Millstone 4-H Center
1296 Mallard Dr.
Ellerbe, NC 28338
Application Due:
March 7, 2008 (please do not fax)
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Name: ____Mr.____Ms.______
Address:______
______
County: ______Date of Birth:______
Business Phone: ______Home Phone: ______
E-mail: ______
The Spring 2008 North Carolina 4-H Shooting Sports Workshop will be held at Millstone 4-H Camp, near Ellerbe, NC. Nationally certified 4-H Shooting Sports instructors from our state will direct the learning experiences. Participants must be at least 18 years old and be registered as a 4-H volunteer in their county. Participants will be selected through an application process. No more than 15 participants will be selected in the disciplines of shotgun, hunting, black powder, and pistol. The cost for the weekend workshop is $25 per person.
Please rank your first, second, and third choice of discipline area (note: you will participate in only one discipline throughout the entire weekend long training):
____ Shotgun ____ Hunting
____ Black Powder ____ Pistol
I have completed the requirements necessary to be listed as a 4-H volunteer in
______county.
Signature of Applicant: ______
Signature of County 4-H Agent______
Amount Paid:______
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Experience with 4-H or Other Youth Organizations
Please describe your experience working with youth through 4-H, Scouts, or similar organizations.
______
______
Previous Shooting Sports Training
List your previous shooting sports training received, and any certification you have received.
Discipline Training Received Date Certification Level
______
______
Shooting Background
Do you have hunting experience? ____Yes ____No
Number of Years ____
Types of Hunting: ______
______
Specialized Training: ______
______
Honors/Recognition: ______
______
Competitive Experience
Do you have competitive experience? ____Yes ____No
Number of Years ______
Disciplines: ______
______
Past/Present Classifications: ______
______
Specialized Training: ______
______
Honors/Recognition: ______
______
Community Activities
Please list your participation in community activities and organizations, and offices or leadership positions held.
Organization or Activity Offices/Leadership Positions Held Honors/Recognition
______
Hobbies/Other Interests
Describe any other interests, skills, or hobbies you enjoy.
______
References
Please list two references who will endorse your qualifications.
Name Address Phone
______
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