Holiday Lake 4-H Educational Center

Virginia Hunter Skills Weekend

May 18-20, 2012

Fill out & submit the form below or Print Registration Form

This reserves your spot, please mail check with full amount to:
Holiday Lake 4H Educational Center
    1267 4-H Camp Road
    Appomattox, VA 24522

Full Name*
First Name Last Name

Name you wish to have one your name tag:*

Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

E-mail*

Phone Number*
- Area Code Phone Number

Birth Date*
Month Day Year

Class sizes are limited, first to register has first choice of classes, parents and youth must take the same classes. For each session pick your top three choices. Your alternate selections (choices 2 & 3) will be used if your first class choice is full. No class changes after arrival.

Saturday, May 19

Session 1- (8:00am-12:00pm)
Session 2- (1:00-5:00pm)

Session 1 - First Choice*

Session 1 - Second Choice*

Session 1 - Third Choice*

Session 2 - First Choice*

Session 2 - Second Choice*

Session 2 - Third Choice*

Sunday, May 20

Session 3- (8:00am-12:00pm)

Session 3 - First Choice*

Session 3 - Second Choice*

Session 3 - Third Choice*

T-shirt size (adult sizes only)*

S M L XL 2XL 3XL

Should be Empty:

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

Please register by: May 4, 2012 Registration Extended to August 24

Refund Policy Full Refund by May 4, 2012 1/2 before May 11, 2012 Nonrefundable after May 11, 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.

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