Official 2009 4-H Registration Form
for the Piscataquis Valley Fair
Please print out and fill out the form below. Mail completed form to Linda Whitten.

Page _____ of ______

Name of Club:  ______________________________________________________

County: _________________________________

Club Leader: ________________________________________________________

Telephone #: __________________________________

Mailing Address (to send check):

____________________________________________________________________

____________________________________________________________________

E-Mail Address: ______________________________________________________

Name & Phone # of person delivering exhibits: _____________________________

Name & Phone # of person picking up exhibits: ____________________________

NOTE: List each member on line ONCE. Allot one line for each project he/she exhibits.