Georgia Envirothon

Georgia Envirothon Pre-Registration

School Name and Address
	School Name:
	Address:
	Address:
	City:	State:	Zip:

Team Affiliation (If registered as an FFA team, all team members must be current FFA members in order to receive FFA award.)
	FFA	4-H	Science/Ecology Club
	Science Class	Home Schooled	Other

Advisor(s)
	Name:
	Name:

Advisor Phone Number
	Work:
	Home:
	Fax:
	Work:
	Home:
	Fax:

Advisor E-mail Address All competition information is provided via e-mail. Make sure you provide a current and maintained address.

Early bird pre-registration (postmarked by December 1): $150 per team. Pre-registration postmarked after December 1: $200 per team. No registration accepted after January 15.

After submitting, print completed application on next page and mail with a check payable to Georgia Envirothon to:

Kim Thompson
Pine County RC&D
105 Martin Luther King Jr. Drive
Soperton, GA 30457