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2020 TSSRM Youth Range Workshop Application
June 21 - 26, 2020 – Texas Tech University Junction Campus – Junction, TX
It is understood that if this application is accepted, a check for $400 must be submitted by May 31, 2020 to cover the applicants meals and lodging, made payable to “TSSRM Youth Activities Committee”. Check will be mailed to Jenny Pluhar PO Box 931 Canyon, TX 79015. Transportation to and from the workshop will be the responsibility of the local sponsoring group, the county agent, agriscience teacher, or advisor of the organization you're representing, or the participant.
* Required
Fellowship and Leadership are a big part of YRW
First Name
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Your answer
Last Name
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Your answer
Age as of June 20, 2021
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Your answer
Date of Birth
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MM
/
DD
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YYYY
School Classification for the '19-'20 school year
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Freshman
Sophomore
Junior
Senior
Other (please explain below)
Male/Female
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Male
Female
Address
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Your answer
City
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Your answer
State
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TX
Zip
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Your answer
County
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Your answer
Email Address
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Your answer
Cell Phone (your cell phone number)
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Your answer
First and Last name of Parent
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Your answer
Parent Email Address
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Your answer
Parent Cell Phone Number
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Your answer
Do you have rangeland plant identification experience? If so, how much?
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No Experience
Very little experience
Some Experience
Experienced
T-Shirt Size
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S
M
L
XL
XXL
Name of Extension Agent, Teacher, or Advisor
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Your answer
Email of Extension Agent, Teacher, or Advisor
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Your answer
Sponsor Group/Organization (this is the group providing funding for you to attend the workshop, if any)
Your answer
Email of Sponsor Group/Organization Representative
Your answer
Do you have any food allergies or any other health issues we should know about? Explaining clearly (certain foods, severity, etc.) will enable us to make any arrangements or take any precautions to ensure a safe experience for everyone!
Your answer
Do you understand.....that you must send payment or make arrangements to do so by JUNE 1, 2021. Payment mailed to Jenny Pluhar, P.O. Box 931, Canyon, TX 79015 or Dan Caudle, 3604 Cliff View
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