Hugo Neighborhood Association & Historical Society

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HUGO WILDFLOWER SUBMISSION FORM

Mail completed form and photo to:

                Mike Brassill   3701 Russell Rd., Grants Pass, OR, 97526

Note:  Your photo will become the property of the Wildflower Committee.

I.   WILDFLOWER

 Common names known to photographer/landowner:_____________________________

Scientific name if known:__________________________________________________

Plant characteristics/information important to photographer/landowner:______________

______________________________________________________________________

II.  PHOTOGRAPHER – Check BOX if you wish this information published on web site.

 o     Name:_________________________________________________

  o       Address:_______________________________________________________

  o     City/State/Zip:___________________________________________

  o     Phone:_________________________________________________

  o     Email (optional):_________________________________________

 III.  DATE OF PHOTO__________________________________________________

IV.  WILDFLOWER LOCATION - Check BOX if you wish this information published.

  o________________________________________________________________

 V.  CAMERA EQUIPMENT (optional)_______________________________________

VI.  LANDOWNER PERMISSION BY_______________________________________

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