In-Person and On-line Registration for FSA-hosted Events and Conference

<insert logo>	EVENT SIGN-IN SHEET USDA FARM SERVICE AGENCY							Revision 2 Date 8.20..25
EVENT NAME:								EVENT DATE:
								CITY AND STATE OF EVENT:
USDA Farm Service Agency (FSA) is collecting participant information to improve our understanding of farmers and ranchers in an effort to monitor our outreach program, specifically to socially disadvantaged and historically underserved farmers and ranchers, and to recommend and implement programmatic and equity improvements. This information is not used to evaluate any FSA program application and choosing not to provide this information will not affect the application process for any individual applying to an FSA program.
Full Name		County and State you live in	Are you currently enrolled in FSA Programs?	What do you grow and/or raise? (Mark all that apply)		Beginning Farmer Rancher and/or Veteran Status (Mark all that apply)	Email or Phone		*QR code
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me		Run by SOCs with Lindsay too long, sign-in sheets for different purposes/types of events part of an event /evaluation
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me
			___ Yes ___ No ___ Not sure	___ Organic ___ Dairy ___ Forestry ___ Fruit and/or vegetable ___ Poultry ___ Livestock other than poultry ___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture ____ Other _________________		__ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share	Email and Phone: ___ Sign me up for newsletters ___ Email or call directly with FSA program outreach ___ Email me FSA employment opportunities ____Do not contact me