2017-2018 MAINE 4-H VOLUNTEER ENROLLMENT

First Name: ______MI: ______Last: ______Family Email: ______Personal Email (if different): ______Mailing Address:______City: ______State: ______Zip: ______County of 4-H Participation: ______Birth Date: ______Primary Phone: ______Mobile Phone: ______Mobile Carrier: Work Phone: ______Years in 4-H: _____ Email Newsletter Wants 4-H Mailings

Gender: Male Female Please provide us with this optional data so that we may report to our federal partners. Hispanic Ethnicity: (check one):  Yes – Hispanic or Latino Ethnicity OR  No -- Not Hispanic or Latino Ethnicity OR  Prefer not to state Racial Groups: (check all that apply):  White  Black or African American  American Indian or Alaskan Native  Native Hawaiian or Other Pacific Islander  Asian  Prefer not to state Residence (Check one):  Farm  Rural non-farm or town less than 10,000  Town/City 10,000 to 50,000  Suburb  City over 50,000 Military Family (optional): Branch: Air Force Army Coast Guard Marines Navy DOD Civilian Branch Component Active Duty National Guard Reserves

Volunteer Role:  Club Leader  Primary Leader  Secondary Leader  School-Based Leader  Spin Club Leader Health Considerations (optional): ______Mark 4-H Projects you are involved in on the back of this form.

Name of Primary 4-H Club 1: ______Club 2: ______Club 3:______

______4-H Volunteer/Leader Signature Date

Published and distributed in furtherance of Acts of Congress of May 8 and June 30, 1914, by the University of Maine Cooperative Extension, the Land Grant University of the state of Maine and the U.S. Department of Agriculture cooperating. Cooperative Extension and other agencies of the U.S.D.A. provide equal opportunities in programs and employment. In complying with the letter and spirit of applicable laws and pursuing its own goals of diversity, the University System shall not discriminate on the grounds of race, color, religion, sex, sexual orientation, including transgender status or gender expression, national origin, citizenship status, age, disability, genetic information, or veteran's status in employment, education, and all other areas of the University System. The University provides reasonable accommodations to qualified individuals Mark  only those project areas in which you will do substantial work this year. Circle projects about which you would like to be kept informed. 4/29/2018

with disabilities upon request. Questions and complaints about discrimination in any area of the University should be directed to the Executive Director of Equal Opportunity, The University of Maine, Room 101, 5754 North Stevens Hall, Orono, ME 04469-5754, telephone (207) 581-1226 (voice and TDD). Any person with a disability who needs accommodations for this program should contact your county office to discuss their needs at least 10 days in advance. Adventure & Challenge ____ Global Education...... ____ Aerospace ...... ____ Goat ...... ____ Ag in the Classroom...... ____ Graphic Arts Displays Exhibits...... ____ Animals ...... ____ Growth Development and Disease...... ____ Animal Sciences...... ____ Health & Lifestyle Education...... ____ Aquaculture ...... ____ Hobbies and Collectibles...... ____ Aquatic Sciences...... ____ Home Environment...... ____ Arts & Crafts ...... ____ Home Nursing, First Aid & CPR...... ____ Astronomy ...... ____ Horse ...... ____ ATV Safety ...... ____ Household Hazardous Waste...... ____ Automotive ...... ____ Intergenerational Programming...... ____ Beef ...... ____ Introduction to 4-H Projects...... ____ Bicycle ...... ____ Leadership Education...... ____ Bicycle Safety...... ____ Leadership Skills Development...... ____ Biological Sciences...... ____ Llama ...... ____ Birds and Poultry...... ____ Marine Science...... ____ Career Exploration & Employability...... ____ Mathematics ...... ____ Cats ...... ____ Meat Science ...... ____ Chemical Health...... ____ Mental and Emotional Health...... ____ Chemistry ...... ____ Mini Society (Entrepreneurship) ...... ____ Child Development, Child Care, Babysitting....____ Music & Sound...... ____ Citizenship (Local, State, National) ...... ____ Ornamental Horticulture...... ____ Clothing and Textiles...... ____ Outdoor Education & Recreation...... ____ Clowning & Mime...... ____ Parenting and Family Education...... ____ Communications Arts...... ____ Performing Arts...... ____ Communications & Expressive Arts...... ____ Personal Development...... ____ Communications for Child Safety...... ____ Personal Development and Leadership...... ____ Community Service ...... ____ Photography ...... ____ Composting ...... ____ Physical Health...... ____ Computer Technology...... ____ Physical Sciences...... ____ Consumer and Family Sciences...... ____ Physics ...... ____ Consumer Education...... ____ Plants ...... ____ Critical Thinking Skills...... ____ Plants and Animals...... ____ Crops & Weeds...... ____ Plant Science ...... ____ Cultural Education...... ____ Poultry Science and Embryology...... ____ Dairy Cattle ...... ____ Rabbits & Cavies...... ____ Dance & Movement...... ____ Range Science...... ____ Dogs ...... ____ Reading Literacy...... ____ Donkey & Mule...... ____ Recycling ...... ____ Drama & Theater...... ____ Safety ...... ____ Drawing & Painting & Sculpture...... ____ Science and Technology...... ____ Earth, Water, and Air...... ____ Science & Technology Literacy...... ____ Eat Well ...... ____ Service Learning...... ____ Economics, Business & Marketing...... ____ Sexual Health ...... ____ Electric ...... ____ Sheep ...... ____ Electronics ...... ____ Shooting Sports...... ____ Emergency Preparedness...... ____ Small Animal & Pocket Pets & Lab Animals....____ Energy ...... ____ Social Recreation Skills...... ____ Engines, Tractors, Field Equipment...... ____ Soils and Soil Conservation...... ____ Entomology and Bees...... ____ Speaking & Radio & TV...... ____ Entrepreneurship (Other) ...... ____ Swine ...... ____ Environmental Education & Earth Sciences...... ____ Technology and Engineering...... ____ Environmental Stewardship & General...... ____ Tractor and Machinery Safety...... ____ Fitness and Sports...... ____ Understanding Physical & Mental Limitations..____ Flower Gardening & House Plants...... ____ Veterinary Sciences...... ____ Food Preservation...... ____ Visual Arts ...... ____ Foods and Nutrition...... ____ Volunteerism ...... ____ Food Science ...... ____ Waste Management...... ____ Foods Safety ...... ____ Water ...... ____ Forestry ...... ____ Weather and Climate...... ____ Forests, Rangeland and Wildlife...... ____ Wildlife and Fisheries...... ____ Gardens-Fruits & Vegetables...... ____ Wood Science & Industrial Arts...... ____ Geology and Minerals...... ____ Working Steer...... ____ GIS & GPS ...... ____ Writing & Print...... ____