EmailMe Form - Alabama Farm-City Video Contest Entry Form

Student's Name

First Last

Student's Age

Grade

Student's Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

County

Student Phone Number

### - ### - ####

Parent's Name

YouTube link to presentation submission

School Name

School Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

School Phone Number

### - ### - ####

Teacher's Name

First Last

As the teacher, I verify that this is a valid entree.

Yes