4-H 510
4-H Logo Protected Under 18 U.S.C. 707
Maryland 4-H Junior Member's Report Form
You are to make a recording for each of your 4-H years on this form
20 ,
Name
,
,
Male
,
,
Female
Address
City
State
Zip
Date of Birth
Years in 4-H: 1
2
3
4
5
6
Parent's Name(s)
4-H Leader(s)
Club or Group
It is the policy of the University of Maryland, Maryland Agriculture Experiment Station, and Maryland Cooperative Extension that
all persons have equal opportunity and access to programs and facilities without regard to race, color, sex, religion, national origin,
age, or disability. The University of Maryland is an Affirmative Action Employer. This material may be available in alternative
formats. (Phone numbers/toll free and TDD/Web site address)