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Applications:

Please fill out the form below, or download a copy to fill out by hand (Word Format, PDF Format).

Name:
Nickname:

Which workshop location are you interested in?

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: / /

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