KENTUCKIANA CHAPTER
SAFARI CLUB INTERNATIONAL

P.O. BOX 221181
LOUISVILLE, KENTUCKY 40252
YOUTH & APPRENTICE PROGRAM
2-DAY TRAINING APPLICATION

aUGUST 4, 5, 2012

NAME ___________________________________________
AGE __________
STREET ADDRESS ________________________________________________
CITY _________________________ STATE ______________ ZIP ___________________
PHONE (_____)____________________ E-MAIL ____________________________
IN CASE OF EMERGENCY CALL: __________________________________________


PHONE: (_____)___________________________________

IF UNDER 21 PLEASE SUBMIT PARENT/LEGAL GUARDIAN INFO:
NAME ___________________________________________ AGE ______________________
STREET ADDRESS ________________________________________________
CITY _________________________ STATE ______________ ZIP ___________________
PHONE (_____)____________________ E-MAIL __________________________



SCI CHAPTER MEMBER YES NO (CIRCLE ONE)

DOES APPLICANT NEED HUNTER EDUCATION SAFETY CARD (ORANGE CARD) YES NO (CIRCLE ONE)

MAIL, FAX OR E-MAIL TO: Mike Ohlmann
4102 Cane Run Rd.
Louisville, KY 40216
FAX: 502-448-1309
E-mail; kysci@mikescustomtaxidermy.com