Name: __________________________________________________ Address: ________________________________________________ ____________________________________ Zip: __________ Phone: Work:_________________ Home: _____________________ Fax: __________________ E-Mail: ____________________ 1. List any previous Horticulture or gardening experience. You may attach a sheet. 2. Are you employed? Full time_______ Part time_______ Are you retired?_______ Present or previous occupations:______________________________ ________________________________________________________ 3. Do you have any medical condition, which may limit your participation in Master Gardeners for physical or outdoor conditions? Describe briefly. _______________________________________________________ _______________________________________________________ 4. Indicate times you can most likely volunteer, weekdays and weekends from 8:00 a.m. – to 8:00 p.m. _______________________________________________________ _______________________________________________________ 5. List your reasons for wanting to become a Louisiana Master Gardener. What do you think you can contribute to the group? _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ Classes will begin January 7, 2009 Please mail or fax the completed application by November 26, 2008 to: 2009 Master Gardener Class 511 Roussell Street Houma, LA 70361 Fax: 985-850-4620