For more information, contact:
Jane Copenhefer
Phone: (740) 366-8821
jane@lickingcounty4hband.com
Are you ready for the 2010 season? Get registered!
Sections:

Home
About the Band
Concert Schedule
Leadership
Photo Album
Online Registration
Message Board
Brick Order Form
Band Flyer (.doc)

Free Guestbook from Bravenet.com 
Register now for the 2010 season!


First Name:
Last Name:
Middle Initial:
Address:
City:
State: Ohio
Zip:
Phone:
E-Mail:
Gender: Male Female
Age:
Birthdate (mm/dd/yy): //
School:
Grade:

Mother's Full Name:
Mother's Occupation:
Mother's E-Mail:
Father's Full Name:
Father's Occupation:
Father's E-Mail:

Years in ALL 4-H (count this year):
Do you belong to any other 4-H club? Yes
No
If yes, name the club:
Years 4-H Band:
Are you a Junior Leader? Yes
No
Principle Instrument:
Other Instruments you can play:
Race: White
Black
Hispanic
Asian
American Indian
Location of home: Town
Farm
Rural
Are you interested in creative arts? Yes
No
List types of creative arts that you participate in:

NEW MEMBERS ONLY!
Who is your sponsor?

OLD MEMBERS ONLY!
Is any of the information above different from last year? Yes
No

Please check to make sure you have filled out this form before sending!
All information will be used only by the Licking County 4-H Band.
When you sign-in at the first practice you will need to pay a $5 fee for registration.
Thank you for registering for the Licking County 4-H Band.


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