4-H Spring Camp 2009

6th Graders—Join us!! Purdue University & Dow AgroSciences Present:

4-H Spring Camp 2009

Aviation--Environment--Technology

It’s FREE!
It’s FUN!
March 30-April 3, 2009
Indiana State Fairgrounds
Breakfast and lunch will be provided

4‐H Camp is limited to just 30 students who will be accepted on a first-come, first served basis-So HURRY!! Fill out the Pre-Registration information form below and submit by

Monday, March 24, 2009

Pre-Registration Form
Please fill out and return to: Phyllis Harris, Extension Educator, Marion County 4-H, 6640 Intech Blvd., Suite 120, Indianapolis, IN 46254 Phone: 275-9305 Fax: 275-9309 E-mail: pgharris@purdue.edu

Student Name:___________________________________
School Attending:________________________________
Home Address:__________________________________________________________________________________
Home Phone:_______________________________
Email Address:_______________________________________
Parent/Guardian Name:____________________________
Parent Work/Cell Number:_________________________
Note: The following information is required by Dow AgroSciences in order for the student to participate in a field trip to their facilities:
Is the student a U.S. Citizen: Yes____ No_____
If No, what country is the student from?________________________________

If this pre-registration form is one of the first 30 received you will then be sent a full registration packet to complete.

**Student is expected to attend all five camp days**