Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

First Parent or Guardian Name & Relationship to Applicant *

First Name

Last Name

Home Phone # of Parent A or Guardian *

(###)

###

####

Cell Phone # of First Parent or Guardian *

(###)

###

####

Second Parent or Guardian Cell Phone

(###)

###

####

Second Parent or Guardian Home Phone

(###)

###

####

Are you a member of Roaring Fork Audubon? *

If not, please join today.

Yes

No

For Camp Purposes *

Male

Female

Other

Birthdate *

MM

DD

YYYY

Which birding camp are you interested in? *

Camp Colorado by the American Birding Association

Taking Flight Overnight Camp (ages 12-14) by Bird Conservancy of the Rockies

On The Wings Overnight Camp (ages 15-18) by Bird Conservancy of the Rockies

I understand that my family will provide transportation to and from camp, and that all transportation arrangements must be completed and described to RFA by May 1st. *

Yes

No

After completion of the camp, I agree to write a short article for RFA describing my experience or give a short presentation by the end of August *

Yes

No

I will email info@roaringforkaudubon.org a letter of recommendation from a current or former teacher or mentor. *

You can also mail us a letter of recommendation to Roaring Fork Audubon Scholarships, PO BOX 1192, Carbondale CO 81623.

Yes

No