Holiday Lake 4-H Educational Center

Traditional Flintlock Rifle Workshop
March 6-10, 2012

Fill out & submit the form below or Print Registration Form and mail it in with your check.

Full Name
First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number
- Area Code Phone Number
E-mail
Gender

Male Female
My rifle should be:

Right Handed Left Handed
Caliber

.32 .36 .40 .45 .50
Should be Empty:

Mail Check to:
Holiday Lake 4H Educational Center
1267 4-H Camp Road
Appomattox, VA 24522

Refund Policy:
- Full: by January 6, 2012
- 50%: after January 6, 2012
- No refund after January 27, 2012

If you are a person with a disability and desire any assistive devices, services or other accommodations to participate in the Workshop, please contact The 4-H Center no later than two weeks prior to the date assistance is needed between the hours of 8:00 a.m. - 4:30 p.m. Monday through Friday.

Holiday Lake 4-H Educational Center programs and employment are open to all, regardless of race, color, national origin, sex, religion, age, disability, political beliefs, sexual orientation, or marital or family status. An equal opportunity/affirmative action employer.

Holiday Lake 4-H Educational Center
1267 4-H Camp Road
Appomattox, VA 24522

Traditional Flintlock Rifle Workshop March 6-10, 2012

Traditional Flintlock Rifle Workshop
March 6-10, 2012