MEMBER ACHIEVEMENT PLAN —1
4-H Membership Pin

Application form

Name ________________________________________________________      Age ____________

4-H Club ______________________________________      County _________________________

The Membership Pin may be awarded at the conclusion of the 4-H year in which you join. In order to receive this pin, you must attend a majority (more than one-half) of the remaining regularly scheduled meetings of your club after the point at which you have joined the club. You may receive this pin only once, and you may receive only one Achievement Pin in a 4-H year.

Number of meetings held: _____________ Number of meetings attended: _____________

Signed: __________________________________________________________________________
4-H’er 								Date

Signed: __________________________________________________________________________
Parent/Guardian 						Date

Signed: __________________________________________________________________________
4-H Leader 							Date

Signed: __________________________________________________________________________
4-H Leader 							Date

Kansas State University Agricultural Experiment Station and Cooperative Extension Service

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nor is criticism implied of similar products not mentioned.

Publications from Kansas State University are available on the World Wide Web at: www.oznet.ksu.edu

Contents of this publication may be freely reproduced for educational purposes. All other rights reserved. In each case, credit
Kansas 4-H Member Achievement Plan 1, Kansas State University, June 2005.

Kansas State University Agricultural Experiment Station and Cooperative Extension Service

	Rice County, 2013

K-State Research and Extension is an equal opportunity provider and employer. Issued in furtherance of Cooperative Extension Work, Acts of May 8 and June 30, 1914, as amended. Kansas State University, County Extension Councils, Extension Districts, and United States Department of Agriculture Cooperating, John Floros, Director.