Team Certification 2023 Team Certification Form This form should be completed by the County Envirothon Coordinator, immediately following the county event and prior to May 4, 2023. County(Required)Adams CountyAllegheny CountyArmstrong CountyBeaver CountyBedford CountyBerks CountyBlair CountyBradford CountyBucks CountyButler CountyCambria CountyCameron CountyCarbon CountyCentre CountyChester CountyClarion CountyClearfield CountyClinton CountyColumbia CountyCrawford CountyCumberland CountyDauphin CountyDelaware CountyElk CountyErie CountyFayette CountyForest CountyFranklin CountyFulton CountyGreene CountyHuntingdon CountyIndiana CountyJefferson CountyJuniata CountyLackawanna CountyLancaster CountyLawrence CountyLebanon CountyLehigh CountyLuzerne CountyLycoming CountyMcKean CountyMercer CountyMifflin CountyMonroe CountyMontgomery CountyMontour CountyNorthampton CountyNorthumberland CountyPerry CountyPhiladelphia CountyPike CountyPotter CountySchuylkill CountySnyder CountySomerset CountySullivan CountySusquehanna CountyTioga CountyUnion CountyVenango CountyWarren CountyWashington CountyWayne CountyWestmoreland CountyWyoming CountyYork CountySchool(Required) Team Advisor(Required) Team Member #1 (Captain)(Required) Grade(Required)9th10th11th12thGender(Required)MaleFemalePrefer to Self-IdentifyTeam Member #2(Required) Grade(Required)9th10th11th12thGender(Required)MaleFemalePrefer to Self-IdentifyTeam Member #3(Required) Grade(Required)9th10th11th12thGender(Required)MaleFemalePrefer to Self-IdentifyTeam Member #4(Required) Grade(Required)9th10th11th12thGender(Required)MaleFemalePrefer to Self-IdentifyTeam Member #5(Required) Grade(Required)9th10th11th12thGender(Required)MaleFemalePrefer to Self-IdentifyCheck all that apply(Required) The orginal 5 member team is participating Substitutions have been made to the orginal 5 member team Team Registration fee of $200 paid* Please explain any substitutions Envirothon Coordinator Signature Date MM slash DD slash YYYY Please Print a copy of this page for your records. $200 Registration fee should be made payable to “Pennsylvania Envirothon” and mailed to: Pennsylvania Envirothon 10541 Route 522 Middleburg, PA 17842 The Envirothon Program is offered and operated on a nondiscriminatory basis without regard to race, color, national origin, religion, sex, age, marital status, or handicap.