4-H Member Enrollment Form

Step 1: Print out this page

Step 2: Fill out the enrollment form. 2006 Enrollment Form

In order to fill out the application you must have Adobe Acrobat Reader.  To download a free version visit http://www.adobe.com/products/acrobat/readstep2.html

Step 3: Print a copy for your records/ or save the file to your computer

Step 4: Submit the data to the 4H office by clicking the SUBMIT button

Step 5: Print out the payment coupon and sign Payment Coupon

Step 6: Send the signed payment coupon and a check ($10.00 per member), payable to UC Regents to - Larry Fossen, UCCE/4-H Amador County, 12200 B Airport Rd, Jackson, CA 95642

Step 7: If the electronic submission does not work, print out the form, sign and mail with a check to the address above.

If you have any questions about enrollment contact Larry Fossen at 209-223-6484