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For a printable version of this document, click here
2010 Maine 4-H Dairy Team
Eastern States Exposition Intent to Participate Form
(Please print or type all information below)
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 December 31, 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 or re-enrolled by December 31 of the current 4-H year.
This form indicates your intent to participate in the 2010 Eastern States 4-H Dairy Show as a representative of Maine. Any Maine 4-H member who is considering team membership in 2010 should fill it out. This form must be completed and postmarked by May 1, 2010 to be eligible for the 2010 Maine 4-H ESE Dairy Team. However, this form alone does not enroll the member on the Maine 4-H ESE Dairy Team.
NOTE: This completed form needs to be postmarked by May 1, 2010
Return Intent to Participate Forms to:
Leanne Moon
24 Village View Lane
Freeport, ME 04032
Telephone: 865-1420
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