4-H 
Name:
Club:
Address:
City: Phone:
Status: (circle one) Leader Teen Leader
Name of workshop you would like to attend:
Date: Cost:
Why do you want to participate in this workshop?:
Suggest an activity you will work on or develop after you return:
Please return to Carisa Hamre, 5772 Castleton Lane, Kalamazoo MI 49009
All Leader Training Scholarship Applications will be considered by the 4-H Leader's Association.
