Important fill out all items

NAME _______________________ COUNTY ________________

ADDRESS ___________________________________
CITY ___________________________________
STATE ZIP ___________________________________

HOME PHONE ____________________________________
CELL PHONE _____________________________________

BIRTHDATE__________ AGE AS OF May 31, 2007 ______________

Circle one MALE FEMALE

PARENTS NAMES: MOM ___________________ DAD __________________

CLUB LEADER’S NAME _______________________
CLUB LEADER’S PHONE ________________
CLUB LEADER’S EMAIL _______________________

Please circle event you are registering for and get a Certified Instructor’s signature.

Air Rifle Archery
Instructor’s Signature__________________ Instructor’s Signature__________________

Muzzleloader .22 Cal Rifle
Instructor’s Signature__________________ Instructor’s Signature__________________

Shotgun
Instructor’s Signature__________________

Do you need to share equipment? Yes No (Please circle)
If yes; what equipment and who will you be sharing with?
If you share equipment you can not shoot in the same squad
______________________________________________________

______________________________________________________

 

THE COST IS $5.00 PER EVENT OR $20.00 ALL EVENTS

Total Cost_______

MAKE CHECKS PAYABLE TO CHEMUNG COUNTY YOUNG GUNS
MAIL COMPLETE FORMS TO:

Dave Decker
3181 Thunder Road
Gillett, Pa 16925