4-H and Michaels Summer SPIN Registration

Grade (2013-14 school year) *

Emergency Contact (Name and Cell) *

By initialing here I give the National 4-H Council, University of Alaska Fairbanks, 4-H Cooperative Extension Service, USDA/NIFA, 4-H Clubs and programs, its nominees, agents and assigns unlimited permissions to copyright and use, publish and republish for purpose of advertising, public relations, trade or any other lawful use, information about me and reproduction of my likeness (photographic or otherwise) and my voice, whether or not related to any affiliation with 4-H, with or without my name. I hereby waive any right that I may have to inspect or approve the copy and/or finished product or products that may be used in connection therewith or the use to which it may be applied. *

Demographics (Optional) *

Male Female

Ethnicity *

Hispanic or Latino Not Hispanic or Latino

Place of Residence *

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Contact Us:
4-H & Youth Development
University of Alaska Fairbanks
Cooperative Extension State Office
1751 Tanana Loop, Room 209
Fairbanks, AK 99775

1-877-520-5211

Alaska 4-H and Michaels SPIN Summer 2013 Session 1