Hunters ED Form

Thurs. Mar 27 2014 7pm -9pm         REGISTRATION FORM Limit 200 Students
and Sat. March 29 2014 7:30am - 5:30pm Free Hunters Safety Course                                       Registration Deadline
At: Rock Island Conservation Club                                                                               Tuesday March 15 2014
Big Island Parkway, Milan, IL                                                        PLEASE CHECK SPELLING

                                           Parents Signature required day of class

Use the students legal name (the name on their Birth Certificate) Absolutely no nicknames

* Indicates required field

NAME (Last) *

(First) *

(Middle Initial) *

AGE *

Birthdate MM/DD/YY *

MALE FEMALE

ADDRESS *

CITY *

STATE *

ZIP *

Phone Number *

A parents written signature required for students under 16 years of age. If a parent will not accompany the student to the class you must mail a signed form to us before you are allowed to take the course.

IOWA STUDENTS MUST BRING THEIR SOCIAL SECURITY NUMBER

Does the above applicant have any special needs

YES NO

If so please explain *

Accepted applicants will be notified by mail about 10 days before class

Do Not Forget To Submit Form

Submit