July 7, 2016 4-H Youth Plant Science Day Registration
County/Chapter: _________________________________________
Name
Age as of
12/31/2016*
Horticulture Contest
Categories:
4-H,Junior 9-14; Senior
15-20; Youth Open,
Adult
Additional Contests
Please Designate
(Speaking,
Demonstration, Poster,
Photography, etc.)
*Participation ages for the national contest are based on age at the end of the competition year so please
adjust the youth participant’s age to reflect this.
Agent/Advisor submitting entry form: _____________________________________________
$10.00 Registration fee will be collected at the event and includes lunch. Please do not enclose
with the registration form.
If participants require special assistance or have special needs, please call 715-485-8600 or e-mail
charles.prissel@ces.uwex.edu.
Please return no later than June 24 to:
Polk County UW-Extension
100 Polk Plaza; Suite 190
Balsam Lake, WI 54810
The University of Wisconsin-Extension provides Title IX requirements which include
affirmative action and equal opportunity in education, programming and employment for all
qualified persons regardless of race, color, gender, creed, disability, religion, national origin, ancestry, age, sexual
orientation, pregnancy, marital or parental status, arrest or conviction record or veteran status.
Requests for reasonable accommodations for disabilities of limitations should be made prior to the date of the
program or activity for which it is needed. Please do so as early as possible prior to the program or activity so that
proper arrangements can be made. Requests are confidential (ADA requirements.)