Trout Unlimited Tri-State Conservation & Fishing Camp

June 22 to June 27, 2008  º   Graves' Mountain Lodge  º   Syria, Virginia

2008 APPLICATION FORM

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 June 2008
  

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; P.O. Box 6463; Alexandria, VA 22306

For information contact:  Suzanne Malone, (703) 768-8175, email malone@tucamp.org

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