HOLIDAY LAKE 4-H EDUCATIONAL CENTER

Traditional Flintlock Rifle Workshop Registration Form

Registration Deadline: November 7, 2008

***The deadline is very early because the parts are custom made and time must be allowed for their construction***

Name_________________________________________________________________________

Address ______________________________________________________________________

City ______________________________________ State _______ Zip Code ____________

Phone_________________________________________________________________________

E-mail ________________________________________________________________________

Male_____ Female______

My Rifle should be:

Rifle Model _____________________________________________________________

Right Handed _______ Left Handed _______

Caliber: 50 _______ or 54 _______

Cost: $1,500.00

Amount Enclosed: _____________

Make Check Payable & Mail registration form to:

Holiday Lake 4-H Educational Center

1267 4-H Camp Road.

Appomattox, VA 24522

(cut and save below for your information)

Traditional Flintlock Rifle Workshop Refund Policy

Meals and lodging fees are refundable; the kit will be shipped to you. You can choose to attend the next workshop at the meals and lodging rate. In the event there is a waiting list and a replacement is available the full fee will be refunded.

- Full: by January 9, 2009

- 50%: after January 9, 2009

- Nonrefundable after: January 16, 2009

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.