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2019 TSSRM Youth Range Workshop Application
June 23 - 28, 2019 – 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, 2019 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.

First Name *
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Last Name *
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Age as of June 23, 2019 *
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Date of Birth *
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YYYY
School Classification for the '18-'19 school year *
Other School Classification
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Male/Female *
Address *
Your answer
City *
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State *
Zip *
Your answer
County *
Your answer
Email Address *
Your answer
Home Phone
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Cell Phone (phone of responsible parent or chaperone bringing you to camp) *
Your answer
First and Last name of Parent *
Your answer
Parent Email Address *
Your answer
Parent Phone Number *
Your answer
Do you have rangeland plant identification experience? If so, how much? *
T-Shirt Size *
4-H Club, FFA Chapter, TSCRA, school club, etc. Represented (write N/A if not applicable) *
Your answer
Name of Extension Agent, Teacher, or Advisor *
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Email of Extension Agent, Teacher, or Advisor *
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Address of Extension Agent, Teacher, or Advisor
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City
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State
Zip
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Sponsor Group/Organization (this is the group providing funding for you to attend the workshop, if any)
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Sponsor Group/Organization Representative
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Email of Sponsor Group/Organization Representative
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Address of Sponsor Group/Organization
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City
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State
Zip
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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!
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