Registration

Online Registration Form:

With the co-operation and support from the Veterans Affairs Office of Juniata County, Pa.

Location: Marysville Sportsmen’s Association Club 217 Kings Hwy, Marysville, Pa. 17053
Date: June 6, 2021 Rain Date: June 13, 2021

Tri County Veterans Trout Derby Registration 2021

* Indicates required field

Name *

First

Last

Phone Number *

Email (if avail.) *

Home Address (Street/Box#) *

Line # 2 (if needed) *

City *

State *

Zip *

Fishing Experience *

"T" Shirt Size: Select One *

Branch of Service *

Does the Veteran have a VA disability rating? *

Does the Veteran require a Care Giver to travel *

Is the Veteran ambulatory? *

To Register by Phone:

Jim Broughton at (985) 285-4923
Steve Ferrante at 717-320-4105

Send It

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** 1st come 1st served. Space is limited. If the registered veteran is unable to attend the Event, please call the above phone numbers so we can arrange a replacement for that slot.**