NAME:________________________________ DATE:________________________

NUMBER IN GROUP:__________________

PERMANENT ADDRESS:______________________________________________

PHONE:_____________________ EMERGENCY PHONE:___________________

ARRIVAL DATE:_____________________ DEPARTURE DATE:______________

This is my application for the Ben Avery Shooting Facility's Host Program. This program allows for a limited amount of hosts to live on site at the Ben Avery Shooting Facility. In exchange for 20 hours of work a week for one host per living site, or 24 hours a week for two, the host(s) is allowed to stay on the Ben Avery Shooting Facility. Host sites have furnished water, electricity, and sewage. Shooting Range BASF Hosts provide a valuable service for the facility and for its customers.

 Do you have experience as a host or volunteer? Please describe:

 Have you been a BASF host/volunteer? What were your duties:

If you are selected as a BASF Host, what area would you like to be assigned?

What skills do you have that you can offer as a BASF H host?

Do you have any health restrictions?