Information Request Form

1

Name* This field is required

First Name

Last Name

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2

Location* This field is required

City

State / Province

Postal / Zip Code

Country

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3

E-mail* This field is required

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4

Link to your LinkedIn, Facebook or Twitter profile, if available(This will greatly assist with prompt verification)

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5

Phone Number(If you'd rather not say at this time, just click NEXT)

Area Code

Phone Number

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7

What is the size of your farm, in acres?* This field is required

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8

How experienced are you as a farmer?* This field is required

Future farmer (not yet farming, but actively trying to)

Beginner farmer (farming for less than 7 years)

Experienced farmer (farming for over 7 years)

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9

Is there anything in particular that you would like to share with us, or anything that you need immediate assistance with?

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