You must have JavaScript enabled to use this form. Personal Information Name Address Address City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code School Grade Age Parent Name(s) Gender Male Female Years in 4-H Phone number Email Race Information Check the appropriate box to describe your race. Information will be used solely for compliance with affirmative action programs. White Black Alaskan/Native American Asian Hawaiian/Pacific Island White and Black White and Black/Native American Black and Alaskan/Native American White and Asian Other Areas of Interest Beef Citizenship Communication/Public Speaking Companion Animal (dog, cat, rabbit) Computers and Technology Consumer Education/Economics Electric Engineering/Safety Science, Entomology Environmental Science/Conservation Food Science Goat Horse Horticulture/Garden Leadership/Personal Development Line and Design Nutrition/Health/Fitness Performing Art/Recreation Photography Plant Science Poultry Sheep Swine and Veterinary Science Leave this field blank