On-Line Registration For FSA-hosted Events and Conferences-Private Sector-Business

Instructions for xxx-xxx

Online Registration Form for FSA-Hosted Events and Conferences

Fld Name/ Item No.	Instruction
1 Prefix	Required entry. Select name prefix of registrant from dropdown box. Choices include “Mr., Mrs., Miss, Dr., The Honorable, Rev.”
2 First Name	Required entry. Enter first name of registrant.
3 Middle name or Initial	Enter middle name or middle initial of registrant.
4 Last name	Required entry. Enter last name of registrant.
5 Email Address	Required entry. Enter email address.
6 Title	Enter title of registrant
7 Company/Organization	Enter Company/Organization.
8 Affiliation	Required entry. Select affiliation. Choices include “College/University, Cooperative Extension, Federal Government Agency, State Government Agency, Non-Profit Organization, Business, Farming, Other”.
9 Country	Required entry. Select the County of residence from the dropdown box
10 Street Address Line One	Required entry. Enter the Street address line 1.
11 Street Address Line Two	As needed, enter the second line of the street address.
12 City	Required entry. Enter the City.
13 State/Province	Required entry. Select the State or Province from the dropdown box.
14 ZIP/Postal Code	Required entry. Enter the ZIP or postal code.
15 Address Type	Required entry. Select the address type from the dropdown box. Choices include “Work Address or Home Address”
16 Phone	Required entry. Enter the 10-diget phone number including area code.
17 Invite People	Enter the first name, last name, and email address of individuals whom you would like to invite to the event. You may enter up to two individuals. In the comment box, add a short message to be included in the invitation.
18 Waivers of Claim and Release of Liability	Read the waivers of claim and release of liability. Check the box to agree to the terms.
19 Do you require specific aids or services?	Check any special service aids you may need to participate in the event.
20 Gender	Select your gender from the dropdown box. Chose from “Male or female”.
21 Veteran Status	Provide your veteran status by selecting the response from the dropdown. Choices include “No or Yes”.
22 Ethnicity	Select your Ethnicity. For this questionnaire, Hispanic or Latino origins are not races. You may select either “Hispanic or Latino” or “Not Hispanic or Latino”
23 Race	Mark all races which apply to registrant. Choices include “American Indian or Alaskan Native, Asian, Black or African American, Native Hawaiian or Pacific Islander, White/Caucasian, Other”. If “Other” is selected, please specify.
24 How did you hear about the event?	Mark the method in which you heard about the event. Choices include “Word of Mouth, Email, Social Media, Publication, At Another Event, Other”. If “Other” is selected, please specify.
25 Choose Registration Option	Choose the registration option by selecting the desired event. Summaries of the event are included on the registration screen.
26 Submit Payment	Select the desired payment type. Complete required payment information as applicable.
Submit	Click the “Submit” button to complete the registration process.