April 16, 2012 - Cabarrus County

Cabarrus County Elma C Lomax Community GardenerApplicationName of Contact Person: __________________________________________________________Address of Contact Person: ________________________________________________________Daytime Phone: _______________________Evening/Weekend Phone: ______________________Contact Person’s Email Address: ____________________________________________________Others who will be gardening with you:________________________________________Emergency Contact Name, Relationship &Number: _______________________________________Your Gardening Skill Level (Does not affect acceptance) ___________________(Add more information on the back or an attached page if needed.)Return application to the NC Cooperative Extension. Do not include check or money.application is accepted.Fee will be due once you are notified that yourNC Cooperative ExtensionCabarrus County Center715 Cabarrus Avenue-WestConcord, NC 28027Phone: 704 920-3310 Fax: 704 920-3323http://cabarrus.ces.ncsu.edu/Distributed in furtherance of the acts of Congress of May 8 and June 30, 1914. North Carolina A&T University commit themselves to positive action tosecure equal opportunities regardless of race, color, creed, national origin, religion, sex, age, or disability. In addition, the two Universities welcome allpersons without regard to sexual orientation. North Carolina State University, North Carolina A&T University, U.S. Department of Agriculture, and localgovernments cooperating.Cabarrus County, Elma C. Lomax Incubator Farm Application Page 1Attachment number 3F-7Page 127