Mercer County 4-H New Member Interest Form

Rock Island County 4-H New Member Interest Form

Fill out and we will be in touch with more details! We are excited to welcome you to 4-H!
Thank you for your interest in joining 4-H where you'll get to explore projects that interest you in more than 150 areas! From rockets to cooking, robotics to horticulture, sewing, visual arts, livestock, dog obedience, shooting sports and more!

We have several 4-H Community Clubs that meet on a regular basis in Rock Island County. We invite you to look over the list and select a club in a location and time that best suits you. We will put you in contact with the leader who will let you know more about their club and the opportuntiies that await! You will enjoy fun activities, special events, community service projects, leadership opportunities, awards, scholarships, friendships, and more in 4-H!

In addition to our community clubs, we also have many workshops and special events that are open to all members. We look forward to having you as part of our 4-H family!

If you have any questions, please don't hesistate to contact 4-H program coordinator Mel Fudge via email @ mfudge@illinois.edu

The Rock Island County 4-H office is located at 321 W 2nd Ave. Milan, IL and the phone number is (309) 756-9978.
Youth Name

First NameMiddle InitialLast Name
Birth Date

MonthDayYear
Gender
2nd Youth Name (if any)

First NameMiddle InitialLast Name
Birth Date

MonthDayYear
Gender
Parent/Guardian Name

First NameMiddle InitialLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent E-mail*
example@example.com
Phone Number*
First choice club you're interested in joining
Second choice club you're interested in joining (if any)
Additional Comments
Should be Empty:

Rock Island County 4-H New Member Interest Form