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2009 Maine 4-H Dairy Team

Eastern States Exposition Intent to Participate Form

(Please print or type all information below)

I,

    I, ____________________________________, am interested in attending the Eastern States Exposition in West Springfield, Massachusetts in September as a member of the Maine 4-H Dairy Team – either with an animal, as a member of the Dairy Bowl team, Fitting Team member, or Judging Team member.

I am in at least my second year of the 4-H Dairy Program.

Age as of January 1, 2009: _______________________

(You must be 12 years old as of December 31, 2009 to try out)

Mailing address: _______________________________________________________________

                            _______________________________________________________________

                            Town _____________________________________ Zip Code ____________

Telephone Number: ____________________________________________________________

My E-Mail address: ____________________________________________________________

Parent’s E-Mail address: ________________________________________________________

Member’s Signature: ___________________________________________________________

Parent/Guardian Signature: ___________________________________ Date: ______________

County Extension Educator Signature: __________________________ Date: ______________
County Educator verifies that 4-Her was enrolled by December 31 of the current 4-H year.

This form indicates your intent to participate in the 2009 Eastern States 4-H Dairy Show as a representative of Maine.  Any Maine 4-H member who is considering team membership in 2009 should fill it out.  This form must be completed and returned by the deadline to be eligible for the 2009 Maine 4-H ESE Dairy Team.  However, this form alone does not enroll the member on the Maine 4-H ESE Dairy Team.

NOTE:  A completed form needs to be returned by May 1, 2009

Return forms to:

Leeanne Moon

24 Village View Lane

Freeport, ME  04032

Telephone: 865-1420

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