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     [   ] 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

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

                                  Galen Westman, (571) 606-0307, email westman@tucamp.org

 

 

Updated Jan. 8, 2019