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Name of Nominee______________________________________________________________________ Address__________________________________________City/State/Zip________________________ Email address:_____________________________________ Phone____________________DOB___________________Age (as of June 13, 2008)________________ Name of Parent or Guardian_____________________________________________________________ Address_______________________________________________________________________________ School (if enrolled)______________________________________________________________________ Grade (Fall of 2008)____________________________________________________________________ Occupation (if working)_________________________________________________________________ Name of 4-H Club______________________________________________Years in 4-H_____________ Organizations (lists names of groups, offices held, etc.) _______________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Ambition______________________________________________________________________________ ______________________________________________________________________________________ Hobbies_______________________________________________________________________________ ______________________________________________________________________________________ Other information or special interests______________________________________________________ ______________________________________________________________________________________ Name of Sponsoring Organization_________________________________________________________ Person Submitting Nomination____________________________________________________________ Mailing Address________________________________________________________________________ Phone_______________________________Sponsorship Fee $25.00 Enclosed______________________
Make checks payable to: Wayne County 4-H Fair Committee, Queen Contest If you cannot find a sponsor please call and we will help find one for you. Mail application and sponsorship to: Wayne County 4-H Queen Committee 2311 Airport Road, Centerville, IN 47330 |
