Growing Lawrence Membership

Farm Information

• * Farm Name
• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• Phone:
• * Address 1:
• Address 2:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Cell Phone:
• Prefix: --Choose-- Mr Mrs Miss Ms Dr Prof Rev Fr Sr Rabbi
• Address 3:
• *

  Would you like to have an Online Listing on GrowingLawrence.org website?

  • Yes
  • No

• Would you like to be added to the email listserv? (Growinglawrence-l@listserv.ksu.edu)

  • Yes
  • No

• Fee

  Type	Fee
  Event fee	$35.00

Demographic Data (Help us Ensure Equity in our efforts.)

• * Gender - Please Specify
• *

  Race

  • American Indian or Alaskan Native
  • Asian
  • Black or African American
  • Native Hawaiian or Other Pacific Islander
  • Other
  • Two or more Mixed Races
  • White or Caucasian
  • Choose not to provide
• *

  Ethnicity

  • Hispanic or Latino
  • Not Hispanic or Latino
  • Choose not to provide

Member Information

You may add a maximum of 4

Business Information

• What types of crops/ livestock are you producing?
• Website:
• Company:
• What Information would you like on your Website Banner? (It could be a Bio, a description of your products, your market venues and hours, etc).
   characters remaining
• Please be sure to forward a photo of your farm/family, (for us to upload to the website), to growinglawrence@gmail.com