2021 Eastern Regional 4-H Shooting Sports Payment Form
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Email *
County Name *
Coach Name *
Payment Summary
Number of Youth Registered *
Tournament Fees = Number of Youth Registered x $20 *
Make checks payable to Edgecombe County 4-H and mail to Edgecombe County Extension Center; PO Box 129; Tarboro, NC 27886.  Please include notes that would be applicable to your payment, if needed.  (example: Check from Nash County 4-H for total registration, etc.):
By submitting this payment form, I certify that a check for the above amount is being mailed to Edgecombe County 4-H, to be received no later than August 20, 2021. *
Required
Listing of Team Coaches
Please provide the names of ALL official team coaches for name tag purposes. These are the certified instructors who may sign off on scores. Please include your name as well.
Coach 1 *
Coach 2
Coach 3
Coach 4
Coach 5
Coach 6
Coach 7
Coach 8
Coach 9
Coach 10
A copy of your responses will be emailed to the address you provided.
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