Sign Up -

Name:
Nickname:

Which workshop location are you interested in? --Choose a Location-- Litchfield, South Carolina - Jan 11-13 2012 Dover, Delaware - Jan 25-27 2012 Greenwood, Mississippi - Jan 30-Feb 1 2012 Grand Forks, North Dakota - March 6-7 2012

Title/Position:

Farm or Company Name:

Business Address:
City: State: Zip:

My Home Address is different from my Business Address.
Home Address:
City: State: Zip:

Home Telephone: () -
Cell Phone: () -
Fax: () -

Email:

Date of Birth: Month 123456789101112 / Day 12345678910111213141516171819202122232425262728293031 / Year 201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930

Breifly describe your responsibilities in the management of the the business: (250 words or less please)

Current Word Count:

Please provide a short paragraph about you and your business that can be shared with faculty: (250 words or less please)

Current Word Count:

Please break down your operation (percentages % only) of total gross income represented by each of the following segments:
% Grains
% Livestock
% Agribusiness
% Non-Agribusiness

What do you consider to be your principal enterprise?

How many people, including yourself, are actively involved in the management of your farm business?

How many total employees (management and non-management) are involved in the business?

How is your business operated?
Sole Proprietorship
Partnership
Public Corporation
LLC or Private Corppratopm
Other

Breifly indicate why you wish to attend the program: (250 words or less please)

Current Word Count:

Remit payment of $595($550 if paid 3 weeks prior to the workshop) to:
Gulke Group
141 W Jackson Blvd Suite 1201A
Chicago, Illinois, 60604