My Name is: Year: ______ My Age: ______ Grade: ______ I belong to ...

My Name is: __________________________________ Year: ________ My Age: ________ Grade: _________ I belong to the: ________________________ 4-H Club

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Name of Activity

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_______________________________ Public Presentation

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______________________________ Exhibit at Fair

Cornell Cooperative Extension is an equal opportunity program provider

My favorite activities this year were: ____________________________________________________ ____________________________________________________

This is something new that I learned in 4-H ____________________________________________________ ____________________________________________________ Here is a picture of my activities. (Draw a picture or attach a photograph to this box.)

Turn in this form by October 1st to the 4-H Office