Fellowship Registration FormPlease enable JavaScript in your browser to complete this form.1Registration & Login Info2Farm Fellowship Profile Information3Program Fee PaymentNameFirstLastFarm Name (will be the username for your subscriber portal)Password PasswordConfirm Password(will be the password for your subscriber portal)EmailBilling AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNextWe’re asking all Farm Fellows to provide this information so we can profile/advertise your farm on our website, social media, and newsletter, as well as to important funders who sustain this program.Farm WebsiteFarm Social Media AccountsFacebookInstagramTwitterTikTokYoutubeOtherNot on SocialFarm FacebookPlease provide the link to this social media platform so we can share it with our networks.Farm Instagram *Please provide the link to this social media platform so we can share it with our networks.Farm Twitter *Please provide the link to this social media platform so we can share it with our networks.Farm Tiktok *Please provide the link to this social media platform so we can share it with our networks.Farm Youtube *Please provide the link to this social media platform so we can share it with our networks.Other Farm Social Media Platform/s *Please provide the link/s to your farm’s other social media so we can share with our networks.Farm Pictures Click or drag files to this area to upload. You can upload up to 5 files. Please upload 1-5 pictures of your farm and yourself on your farm. If you don’t have a farm yet or don’t have pictures of your farm please just upload 1 or more photos of yourself. These pictures will be very important for our fundraising efforts for this program, so please provide the best pictures you can. A heads up that, it takes a few seconds for the files to load fully and the form will not allow you to move forward until they do.NextChoose Your Payment Plan *AnnualSemi-AnnualQuarterlyOne YearDiscounted RatePlease check this box if you’ve already paidPlease check this box if you’ve been approved for a discountPlease select the appropriate discount *25% 50%75%Track – Annual *Grower Track – $ 600.00Breeder Track – $ 1,200.00Help us cover your payment processing fee – $ 18.00Help us cover your payment processing fee – $ 36.00Track – Annual 25% off *Grower Track – $ 450.00Breeder Track – $ 900.00Help us cover your payment processing fee – $ 13.50Help us cover your payment processing fee – $ 27.00Track – Annual 50% off *Grower Track – $ 300.00Breeder Track – $ 600.00Help us cover your payment processing fee – $ 9.00Help us cover your payment processing fee – $ 18.00Track – Annual 75% off *Grower Track – $ 150.00Breeder Track – $ 300.00Help us cover your payment processing fee – $ 4.50Help us cover your payment processing fee – $ 9.00Track – Semi Annual *Grower Track – $ 300.00Breeder Track – $ 600.00Help us cover your payment processing fee – $ 9.00Help us cover your payment processing fee – $ 18.00Track – Semi Annual 25% off *Grower Track – $ 225.00Breeder Track – $ 450.00Help us cover your payment processing fee – $ 6.75Help us cover your payment processing fee – $ 13.50Track – Semi Annual 50% off *Grower Track – $ 150.00Breeder Track – $ 300.00Help us cover your payment processing fee – $ 4.50Help us cover your payment processing fee – $ 9.00Track – Semi Annual 75% off *Grower Track – $ 75.00Breeder Track – $ 150.00Help us cover your payment processing fee – $ 2.25Help us cover your payment processing fee – $ 4.50Track – Quarterly *Grower Track – $ 150.00Breeder Track – $ 300.00Help us cover your payment processing fee – $ 4.50Help us cover your payment processing fee – $ 9.00Track – Quarterly 25% off *Grower Track – $ 112.50Breeder Track – $ 225.00Help us cover your payment processing fee – $ 3.38Help us cover your payment processing fee – $ 6.75Track – Quarterly 50% off *Grower Track – $ 75.00Breeder Track – $ 150.00Help us cover your payment processing fee – $ 2.25Help us cover your payment processing fee – $ 4.50Track – Quarterly 75% off *Grower Track – $ 37.50Breeder Track – $ 75.00Help us cover your payment processing fee – $ 1.13Help us cover your payment processing fee – $ 2.25Custom Captcha *Please enter your code here Total$ 0.00PayPal Commerce *PayPal CheckoutCredit CardCard NumberExpiration DateSecurity CodeCard Holder NameStripe Credit Card *CardName on CardPreviousRegister
