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2008 Maine 4-H Equestrian Team

Intent to Participate at Maine Eastern States Tryouts

I, ________________________________, am interested in attending the Maine Eastern States Tryouts in June 2008 and I am currently enrolled in ____________________ County 4-H Horse Program.

Age as of January 1, 2008:     _____________________

(You must be 12 years old as of January 1, 2008 to try out)

Mailing Address:        __________________________________________________________

                                    __________________________________________________________

                                     Town  _______________________________ Zip Code  ____________

Telephone Number:     __________________________________________________________

My E-Mail Address:  __________________________________________________________

My Parent’s E-Mail Address:   ___________________________________________________

_________________________________________________          Date:  _________________

Rider/Teen Leader Signature

_________________________________________________          Date:___________________

Parent/Guardian Signature

_________________________________________________          Date:  __________________

County Extension Educator/Staff Signature

County Educator verifies that 4-Her was enrolled by December 31 of the current 4-H year.

CHOOSE ONLY ONE

                                        ___ Driving

                                        ___    Teen Leader

NOTE:  A completed form should be mailed to Kate Slattery by April 1^st

Kate Slattery

348 Bog Rd.

Gilead, ME 04217