Government-In-Action Youth Tour

Essay Contest Application

Enclose a 500 Word Essay on

 “The History of Electric Cooperatives”

Deadline – 5:00 PM March 11, 2011

Name:_________________________________________________

Address:________________________________________________

City: _________________   State: ______  Zip: __________

Phone: _________________ Birth Date: ________________

School & Grade:

 _________________________________________________

Parent or Guardian's Name:

 _________________________________________________

 Parent or Guardian's Signature:

 _________________________________________________

List the account number of the Coop member that you are applying under:

 __________________________________________________

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