4-H Day Presented by Co-op
Deadline for Application is March 20, 2015
March 28
Edmonton EXPO Centre
Name of 4-H Member
Name of 4-H Club
__________________________________________________________________________________
________________________________ Type of 4-H Project ___________________________________
Name of 4-H Member’s Parent/Legal Guardian ___________________________________________________________________
(if 4-H Member is under the age of 18)
4-H member Address ________________________________________________________________________________________
4-H member Phone Number ______ ________________________ 4-H Member E-mail Address ___________________________
FREE Admission for 4-H Members
Members must show their 4-H ID card or an article of 4-H Club clothing at the 4-H Day registration desk to receive
FREE Northlands Farm & Ranch Show admission on March 28, 2015 only. Parents and non-4-H members
will be required to pay the $5 Northlands Farm & Ranch Show admission fee.
Ticket Discount for 4-H Club members
We are pleased to offer 4-H Club members, their friends and family a discount for the Canadian College Finals Rodeo,
March 26-28, 2015.This discount is only available on-line at www.ticketmaster.ca/4hclub. To receive the discount,
enter 4HCLUB in the promotions/special offer box. For groups of 20 or more, please contact Group Sales Office at
780.491.3406, Toll Free at 1.888.800.7275 or by e-mail at [email protected].
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The 4-H Member or their parent/legal guardian (“Member”) authorizes the use of the above information to
Edmonton Northlands (“Northlands”) to administer the 4-H Day program and verifies the information provided.
Northlands agrees to use their personal information only for the purpose of organizing 4-H Day, and will not to
share or distribute this information to any other third party. The Member consents to allow Northlands to provide
them with electronic communications.
The Member understands that by participating in 4-H Day, photographs or videos may be taken of the Member. By
signing this form, the Member consents to the reproduction and usage of their likeness at all times thereafter, by
Northlands, its photographer, camera operator and any other nominee or designee in all forms and media, and in
all manners including without limitation advertising, sale, publicizing of the 4-H Day, trade, display, editorial, art,
television commercials, online and exhibitions in any and all media throughout the world.
Without limiting the generality of the foregoing, the Member consents to allow Northlands to use their image, their
voice, conversation and sounds for such things as promotional videos, print advertisements, and similar, in connection
with their attendance at this event. The Member agrees that Northlands will be the exclusive owner of any
recording of the appearances, to use and to license others to use, in any manner, any portion of the recording. The
Member hereby waives any right of inspection or approval of their appearance or the uses to which such appearance may
be put.
__________________________________________________
Signature of 4-H Member
_____________________________________________________
Signature of Parent/Guardian (if 4-H Member is under the age of 18)
__________________________________________________
Name of Member (please print)
_____________________________________________________
Name of Parent/Guardian (please print)
__________________________________________________
Date
_____________________________________________________
Date
Submit COMPLETED registration forms to Jacob Onyschuk:
Fax: 780.471.8169
E-mail: [email protected]
Phone: 780.378.8401
Cell: 780.292.0057
Mail: Northlands Events
P.O. Box 1480
Edmonton, AB T5J 2N5