County Summary for Ak-Sar-Ben 4-H DNA Collections
County___________________ State _Iowa____________
_____ If a Waiver is needed, make sure it is paper clipped to the hair sample envelope. Please
do not staple anything together.
_____ Return the Hair Sample envelopes (with waiver if needed), all damaged hair envelopes
and unused hair envelopes to the Ak-Sar-Ben 4-H Stock Show, 8707 West Center Rd., Ste. 101,
Omaha, Nebraska 68124.
_____ It is a good idea, but not required that you send the package via hand deliver, UPS or FED
EX, etc., any method with a tracking system to the Ak-Sar-Ben 4-H Stock Sow, 8707
West Center Rd., Ste. 101, Omaha, Nebraska 68124.
Complete the following and include it with the materials sent:
TOTAL
NUMBER
Number of hair samples forwarded
Number of Parental Waivers forwarded
Number of Exhibitor Waivers forwarded
Number of damaged hair envelopes forwarded
Number of unused hair envelopes forwarded
Payment to be forwarded:
# of Hair Samples _________ X $5.00 = __________ total due
Checks can be made payable to the Ak-Sar-Ben 4-H Stock Show. If check is not included with
summary please indicate the date to expect payment:________________________
(make a copy of this form to use later when you submit DNA for Sheep, Goats, Pigs and Feeder
Calves)