Name:

Address:

City:   State:   Zip Code:

Home Phone:

Cell Phone:

Email:

County:

Gender: Male Female

Age:   I will be attending the grade in the fall of 2008.

I will attend the  June 9-11 Camp  June 16-18 Camp

T-shirt, Adult size: small  medium  large  x-large  xx-large

Parent or Guardian Name:

4-H Agent or Ag Teacher:

Roommate Preference:

**Sunday Evening:

**If students from a distance need to come in on Sunday evening, please note that on the form and contact Brian Anderson.

(Click submit button once.  It might take a few moments for the form to be processed.  You will directed to a confirmation page once the form has been submitted).