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Virtual 4-H Club: Discovering Food
Online Membership Application Form
To be completed by individuals applying as a Youth Member OR Volunteer Leader
Web page will contain blanks for the following information that will be submitted electronically:
I am applying to be a:
Youth Member
Volunteer Leader
First Name:
Last Name:
Address:
City:
State:
Zip:
County:
Phone:
Email:
Age: (
as of January 1
) (
If applying as a youth member)
I am plan to be a 4-H Club Member or Volunteer Leader in a Nebraska county during 2008:
Yes
No
I have read the Virtual 4-H Club Fact Sheet:
Yes
No
2008 UNL Extension, 4-H Youth Development, Lincoln, NE 68583 (402) 472-2805
Contact Webmaster
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