Registration

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

Online Registration Form:

Tri County Veterans Trout Derby Registration 2024 Registration

* 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? *

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
*Derby date 2 June 2024

Send It

Home

** 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.**