4-H Robotics Event - North Dakota State University

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Nov 2, 2013 (4 years and 10 days ago)

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Registration Form
Please send one registration form per person.
Name
______________________________________
Parent/Guardian Name
________________________
Address
_____________________________________
City
_________________
State
___
ZIP
__________
Phone ( ______ )
______________________________
County
_____________________________________
E-mail
______________________________________
Please check:
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Youth
m
Chaperone
If youth, chaperone name
______________________
For our reporting purposes, please complete the

following information:

m
Male
m
Female
I live:

m
on a farm
m
town under 10,000


m
rural area/nonfarm
m
town over 10,000
Age: (youth only)
_____________________________
I am an enrolled 4-H member/leader:

m
Yes
m
No
Race:

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White
m
American Indian


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Black or Alaskan Native


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Asian
m
Native Hawaiian or


m
Prefer not to state Pacific Islander
(please complete both sides or register online)
4-H
robotics
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the conditions of our Creative Commons license. You may copy, distribute,
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North Dakota State University does not discriminate on the basis of age,
color, disability, gender expression/identity, genetic information, marital
status, national origin, public assistance status, sex, sexual orientation,
status as a U.S. veteran, race or religion. Direct inquiries to the Vice President
for Equity, Diversity and Global Outreach, 205 Old Main, (701)231-7708. This
publication will be made available in alternative formats for people with
disabilities upon request, (701) 231-7881.
For More Information
Linda Hauge

NDSU Extension Service

Center for 4-H Youth Development

(701) 231-7964

linda.hauge@ndsu.edu.
4-H
robotics
4-H
robotics
2012 4-H

Robotics
Event
Saturday, Sept. 15

10 a.m. to 4 p.m.
Mandan High School

905 8th Ave. NW
(please complete both sides or register online)
Individuals with disabilities are invited to request
reasonable accommodations to participate in
NDSU-sponsored programs and events.
To request an accommodation(s), please contact
Holly Halvorson at (701) 231-7251 by Sept. 7 to
make arrangements.
Registration
Registration fee:
$20 for youth (supplies and lunch)

$10 for adult (lunch)
Register online at:
www.ndsu.edu/4h
Or complete this registration form with

payment to your local county extension office:
www.ag.ndsu.edu/extension/

county-extension-offices
Make checks payable to:

North Dakota 4-H Foundation
Method of payment:


m
Cash
m
Check
4-H
robotics
2012 4-H Robotics Event
Learn About Robotics
Want to know more about robotics?
Spend a day filled with hands-on
junk and WeDo robotics training and
challenges.
Who Can Attend
This event is open to youth who will

be in fourth to sixth grade during the
2012-13 school year. It will be limited

to 30 participants.
Saturday, Sept. 15
n
Mandan High School, 905 8th Ave. NW
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10 a.m. to 4 p.m.