Mailing List Form

Please print out, complete and mail this form to receive notices about 
educational programs and activities from Cooperative Extension in 
New Castle County.

   Name_________________________________________________________________

   Address______________________________________________________________

   City________________________________ State______ ZIP + 4 ____________

   Daytime phone_____________________ Evening phone_____________________
   
   ___ Send information to my email address: ___________________________
   
   Race: ___ Asian or Pacific Islander  ___Black       ___ Hispanic
   
         ___ Native American            ___ White
         
   Gender: ___Female  ___ Male

   Your Signature _______________________________ Today’s Date _________ 

Please check program area(s) of interest to you and your family:

   ___ Home Lawns, Gardens & Pests  ___ Bicycle safety
   ___ Master Gardener training         ___ Car seat safety
   ___ Garden Check newsletter          ___ Pedestrian safety
       subscription information         ___ SAFE KIDS Coalition
   ___ 4-H & Youth Development          ___ Child Passenger Safety
   ___ Family & Consumer issues              Technician/Instructor training
   ___ Financial Management newsletter
       subscription information
   ___ Parenting newsletter
       subscription information
   ___ Family & Community
       Education clubs
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COMMERCIAL AGRICULTURE ONLY: 

   ___ Ag Science Teacher
   ___ Ag Supplier for >     ___ Dairy 
   ___ Ag Consultant for >   ___ Horses 
   ___ Ag Producer of >      ___ Other Livestock _____________  
                                ___ Corn Grain & Silage          
                                ___ Small Grains
                                ___ Soybeans   
                                ___ Hay & Pasture                     
                                ___ Nursery & Greenhouse
                                ___ Commercial Tree Fruit
                                ___ Commercial Small Fruit
                                ___ Commercial Vegetables
                                ___ Christmas trees
                                ___ Other crops _______________
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Mail to: NCC Cooperative Extension
         461 Wyoming Road, Room 131
         Newark, DE 19716-1303

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Copyright © 2007 NCC Cooperative Extension.

It is the policy of the Delaware Cooperative Extension System that no person shall be subjected to discrimination on the grounds of race, color, sex, disability, age, or national origin.