4-H WASHINGTON D.C. TRIP APPLICATION - - 2022

 

Due in Extension Office – April 30, 2021

$200.00 deposit (non-refundable) must accompany application and book.

Make check payable to VALLEY COUNTY 4-H D.C. FUND

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 NAME ________________________________________________________________________

 MAILING ADDRESS _____________________________________________________________

 PHONE #      home: ______________    cell: ______________     

 YOUR e-mail address: ___________________________________________________________                

 BIRTH DATE ______________                        YEAR IN SCHOOL ________________

 YEAR IN 4-H_______________                       AGE as of 10/1/2021 ____________

 

What sights or things are you looking forward to seeing on this trip?

 

 

 

 

 

 

Why do you want to go?

 

 

 

 

 

 

 

 

Parents/Guardian  ____________________________________________________

 Address  ____________________________________________________________