| 2010 KANSAS ENVIROTHON TEAM REGISTRATION FORM |
| Please complete this form and return it by March 31. No forms or teams will be accepted if received after April 20. |
| By Mail return to: Peggy Ricker % Lane County Conservation District PO Box 985 Dighton, KS 67839-0985 Or Fax to: ATT: Peggy Ricker 620-397-5773 Ext. 106 |
| * TEAM (School Name): _____________________________________________________ * COUNTY Name: ________________________________________________ |
| * Team Members Names |
| *FFA Member Yes/No |
| *Grade During 2009/2010 School Year |
| *T-Shirt Size Medium Large X-Large XX-Large |
| 1. _______________________ ___________________________________ __________ *name - teacher/advisor * day time phone & * e-mail * T-shirt size 2. _______________________ ___________________________________ __________ *name - teacher/advisor * day time phone & * e-mail * T-shirt size * Required Information |
| * # Years Participate Include This Year. |
| ________________________ __________ __________ __________ __________ (captain) _________________________ __________ __________ __________ __________ _________________________ __________ __________ __________ __________ _________________________ __________ __________ __________ __________ _________________________ __________ __________ __________ __________ |
| Page Last Modified 06/15/2009 |