2008
New York State 4-H Shooting Sports
State Shoot Information Individual
Registration Form
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
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