SIgn in sheet format.xlsx

In-Person and On-line Registration for FSA-hosted Events and Conferences.

SIgn in sheet format.xlsx

OMB: 0560-0226

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<insert logo> EVENT SIGN-IN SHEET USDA FARM SERVICE AGENCY Revision 1 Date 9.1.22
EVENT NAME:
EVENT DATE:
OTIS ACTIVITY NUMBER
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 undersered farmers and ranchers, and to recommend and implement programmatic and equity improvements. This informaiton is not used to evaluate any FSA program application and choosing not to provide this information will not affect the aplication process for any individual applying to an FSA program.
Full Name County and State you live in Are you currently enrolled in FSA Programs? (Mark all that apply) What do you grow and/or raise? (Mark all that apply) Gender Identity Ethnicity Race (Mark all that apply) Beginning Farmer Rancher and/or Veteran Status (Mark all that apply) Email or Phone


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me


___ Yes ___ No ___ Not sure ___ Conventional
___ Organic
___ Dairy
___ Forestry
___ Fruit and/or vegetable
___ Livestock other than poultry
___ Poultry
___Urban Ag ___ Hydroponics ___ Aquaponics ___Aquaculture ___ Floriculture
____ Other _________________
__ Female __ Male __ Non-binary __ I prefer not to share __ Hispanic or Latino __ Not Hispanic or Latino __ I prefer not to share __ American Indian or Alaska Native __ Asian __ Black /African American __ Native Hawaiian or Pacific Islander __ White __ I prefer not to share __ I have farmed independently for 10 years or less __ I am a Veteran __ I prefer not to share Email and Phone: ________________________________________________________________________________________________ ___ Email or call me ___ Sign me up for newsletters ___ Do not contact me
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