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Central Shooting Sports Certification Workshop Registration



4-H Shooting Sports, Central Wisconsin Adult 4-H Leader Certification, Marshfield, WI
Central Wisconsin Sportsmen's Club
11841 Stadt Road
Marshfield,WI 54449
Map


September 13 - 14, 2019
Friday 6-10pm; Saturday 8am-5pm
Certifications Offered: Archery, air pistol/pistol, air rifle/rifle, coordinator, muzzleloader,shotgun


Deadline: Friday, September 6, 2019
After the deadline contact Doug Thompson
douglas.thompson@wisc.edu
920-391-4657

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Friday, September 13, 2019 – 6-10 pm – Saturday, September 14, 2019 – 8 am-5 pm
Please note: If you completed a Friday evening Guidelines Session in 2017, 2018 or 2019 you need only register for a Saturday discipline of choice and pay a reduced $55 workshop fee. All certifications require attendance at the complete 8- or 12-hour workshop. Registration Deadline: Friday, September 6, 2019 (Contact Doug Thompson at 920-391-4657 after this date for availability.)
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Certifications: You can only complete one certification per workshop. Certifications can be added at future workshops.
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Registration Deadline: September 6, 2019
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Fee for both Friday and Saturday Sessions: $70* (Includes instructor manual, equipment, ammunition, Friday pm snack, Saturday lunch, and Saturday am and pm snacks.) Please check in before 6 pm on Friday and before 8 am on Saturday.
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Fee for Saturday Discipline Certification only: $55* (Includes instructor manual, equipment, ammunition, Saturday lunch, and Saturday am and pm snacks.) Please check in by 8 am on Saturday.
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*Reduced Fee for one spouse if both spouses attend same workshop/discipline: $25 (When both spouses attend the same certification workshop taking the same discipline the $25 rate for one spouse applies. $70+$25=$95 or $55+$25=$80.)
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What is provided: Instructor discipline notebook, snacks Friday & Saturday, Saturday lunch and range equipment during the certification workshop.

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What you can bring: Whistle if you are in archery, eye/ear protection if in pistol, rifle, shotgun or muzzleloader.
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YOU WILL MAKE ONLINE PAYMENT ONCE YOUR REGISTRATION IS SUBMITTED, you will be re-directed to a secure website for payment. Be sure to enter 4-H Shooting Sports Workshop in the Program Area box and print the receipt that appears when payment is submitted.
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If you have any questions or difficulties with this form, please call Extension Brown County office at 920-391-4650. If you have any questions regarding the Shooting Sports Program, please email douglas.thompson@wisc.edu or call 920-391-4657.
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Weather Conditions: Outside ranges may be used; dress appropriately for outdoor conditions.
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Registration Form
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Email Address:
Comments:
Home Phone Number:
Cell Phone number:
Name of county where you will be a shooting sports instruction:
Check all that apply:
Adult 4-H Leader currently enrolled in a county 4-H program through 4-H Online
I am NOT currently enrolled in a county 4-H program through 4-H Online
I am enrolled in a county 4-H program but have NOT completed required 4-H Leader Orientation
This is the first time I have ever attended a 4-H Shooting Sports Certification
I am currently certified in at least one 4-H Shooting Sports Certification
I want to be certified to teach for another organization, but not 4-H (please name the organization in the box below)
I want to be certified to teach for another organization, plus teach in 4-H (Please name the organization in the box below)
Discipline requested - Please choose only one:
Archery
Coordinator
Air Rifle/Rifle
Air Pistol/Pistol
Muzzleloader
Shotgun
Lunch Choice:
Ham
Turkey
Veggie
Please provide diet restrictions:
Please provide any limited restrictions regarding your participation in event activities or accommodations needed.:
Need certification for another organization - list organization:
Adult 4-H SS Leader - list disciplines held:
I will be attending:
September 13 & 14
September 14
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