Communicating for Agriculture's Future

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Communicating for Agriculture's Future

This is the registration form for the Issues and Agriculture program which is taking place January 18 6:00-8:00 pm, January 25 6:00-8:00 pm, and February 1 6:00-8:00 pm at 708 S. Union St., Auburn, IN 46706. 4-H members who attend all 3 session will receive 3 credits to replace worksheets in 3 species of their choosing.

Email *

Youth First Name *

Youth Last Name *

Youth Grade: *

Youth Gender *

Male

Female

Non-Binary (not a girl or a boy)

Prefer not to say

Other:

Race/Ethnicity (Check all that apply) *

Hispanic, Latino, Latinx, or Spanish

Middle Eastern or North African

White

Black or African American

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

I don't know, or I prefer not to answer

Other:

Required

Cell Phone Number (in case of weather cancellation, a call or text will be sent out) *

What county do you live in? *

Adams

Allen

DeKalb

Huntington

LaGrange

Noble

Steuben

Wells

Whitley

Other:

Do you require any physical accommodations? *

Yes

If you answered yes to the previous question, please give us more details so that we can make accommodations.

Are there any ag issues you would like to see covered?

Submit

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