Trout Unlimited Tri-State Conservation & Fishing Camp

Graves' Mountain Lodge    Syria, Virginia

APPLICATION FORM

See www.tucamp.org for camp information

 

Name of Applicant _______________________________________________________________ 

 

Date of Birth______________________             Male ___    Female ___

 

Names(s) of Parent(s) or Guardian(s) _____________________________________________

 

Address:            Street ____________________________________________________________

 

                            City ____________________________    State ________    ZIP ______________

 

Telephone _________________________    Email _____________________________________

 

Current Grade:   (check one)     [   ] 8       [   ] 9       [   ] 10      [   ] 11      [   ]  or will be 13 years old by start of camp
  

Teacher or Counselor Reference:

 

      Name __________________________    Title or Position _____________________________

 

      Telephone:   Day __________________    Evening (required please) _______________________

 

      Email __________________________________________

 

Essay.   Please write a brief statement answering the three questions below:

     -  Why you are interested in attending the camp?  

     -  What you want to get from the camp?  

     -  If selected to attend, what you would do to help make the camp successful?

(Please type or write clearly.  If needed, continue essay on back or attach an additional sheet.)

 

Mail to:  TU Tri-State Conservation & Fishing Camp

             c/o Suzanne Malone, 14030 Roanoke Street, Woodbridge, VA 22191

 

For information contact:  Suzanne Malone, (571) 641-9705, email malone@tucamp.org

                                         or Paul Kearney, (540) 229-0563, email kearney@tucamp.org.

 

 

Updated Nov. 18, 2009