Farmer Veteran Coalition Membership Form
Please fill out the following form to become a member of the Farmer Veteran Coalition (FVC). Everyone is welcome to register - veteran or not. Once you have completed this form, you will be signed up to receive regular Farmer Veteran Coalition communications. Thank you!
Questions marked with a red asterisk are required in order to successfully submit this form.
Contact Information
First Name
Last Name
Mailing Street
Mailing City
Phone (Must enter as ###-###-####)
Email
Mailing State / Province
Please select...
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
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Mailing Zip/Postal Code
Mailing Country
Please select...
US
Puerto Rico
Guam
Virgin Islands
Northern Mariana Islands
American Samoa
Palau
Are you a veteran or military service member?
Yes
No
Military Service Questions
Current Military Status
Currently Serving
Separated
Retired
Military Branch
Army
Navy
Marine Corps
Coast Guard
Air Force
Type of Service
Active Duty
National Guard/Reserves
Date of Service Entry (Must enter as: MM/DD/YYYY)
Date of Separation (If still serving, leave blank.) (Must enter as: MM/DD/YYYY)
Please indicate the Era(s) in which you served (check all that apply).
WWII
Korean War
Vietnam War
Cold War
Desert Storm
GWOT
Other
In your time of service, did you deploy?
Yes
No
Deployment Information
Number of Deployments
Please select...
1
2
3
4
5
6
7
8
9 +
0
Location of Deployments (Check all that apply)
Desert Storm
OIF
OEF
Vietnam
Other
None
Location of Deployment (if Other)
Do you have a service-connected disability?
Yes
No
What is your disability rating?
Please select...
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Agriculture Questions
How long have you been farming or ranching?
I have not farmed or ranched.
Less than 2 years
2-5 years
6-10 years
More than 10 years
Please describe your past agricultural involvement.
Which of these best describes your current involvement in agriculture?
Owner/operator of an agricultural business
Employee of an agricultural business
Intern on a farm
Volunteer on a farm
Student in an agricultural program
No current involvement
Current Involvement in Agriculture
Please tell us about your current involvement in agriculture (the more detail, the better, as it it makes it easier for us to connect and serve you):
What is the name of the agricultural business you currently own/operate or work for?
What is the business's website or Facebook page?
What products do you produce? (Check all that apply):
Vegetables
Commodities (e.g. corn, soy, wheat, rice, cotton)
Melons
Fruit Trees
Nut Trees
Berries
Grapes
Herbs
Flowers
Lumber
Dairy
Beef
Pork
Sheep
Goats
Poultry
Horses
Fish / Shellfish
Bees
Other Livestock (exotics)
Other
Value-Added Products (e.g. canned goods, spices, sauces, soaps)
Fiber
Compost
None of the Above
Do you Own or Lease your facility/property
Own
Lease
Exact Acreage (Enter as numbers without commas, e.g. 1200)
Which of these best describe your operation (Check all that apply):
Urban
Organic
Conventional
Sustainable (Low-input)
Hydroponics
Aquaponics
Dry Farming
Homesteading
Permaculture
Aquaculture
What were your previous year's gross sales? (
Note:
We do not share or report individual's gross sales. We use the sum total of all of our members' gross sales to measure the economic impact of our members.)
Do you have a processing facility on your farm?
Yes
No
Please describe the products that you process:
Where do you primarily distribute your products?
Nationally
Locally (within the state or 275 miles)
Goals, History, and Assistance
What are your current agricultural career goals? Please describe in as much detail as possible.
What steps have you already taken towards achieving those goals? Please describe in as much detail as possible.
Farmer Veteran Coalition offers Career & Education Consultation, Workshops & Webinars, Legal Assistance, the Homegrown by Heroes Label, Government Resources Advising, the Farming Fellowship Fund, and a National Network of Allies.
What type of assistance are you seeking from Farmer Veteran Coalition?
Supporting the Farmer Veteran Coalition
Are you interested in volunteering as a mentor for beginning farmer veterans? Mentors are assigned on a case by case basis. We will contact volunteers as needed.
Yes
Not at this time
Can you offer a job or internship to a Farmer Veteran Coalition Member?
Yes
Not at this time
Please briefly describe the job or internship that you can offer:
Can we provide job/intern seeking members with your contact information
Yes
No
Would you like to share your knowledge, skills and expertise with Farmer Veteran Coalition Members?
Yes
Not at this time
Please describe your area(s) of expertise:
Are you interested in passing on land to a veteran?
Yes
Not at this time
Would you like to make a donation to the Farmer Veteran Coalition?
Yes
Not at this time
Donating to Farmer Veteran Coalition
Thank you for your desire to support the mission of Farmer Veteran Coalition. You can donate anytime through PayPal by clicking
here
.
What type of donation would you like to make to the Farmer Veteran Coalition?
Monetary
Other
Please describe the donation that you would like to make to Farmer Veteran Coalition:
Demographic Information
Date of Birth (Must enter as MM/DD/YYYY)
How do you identify yourself in terms of gender?
Man
Woman
Prefer Not to Answer
How do you identify yourself in terms of race or ethnicity?
Please select...
Arab-American or Middle Eastern
Asian-American
Black or African-American
Latino or Hispanic
Native American
Pacific Islander
White or Caucasian
More Than One Race
Other
Prefer Not to Answer
How did you learn of Farmer Veteran Coalition?
Please select...
Online
Social Media
Media
Friend / Family / Colleague
Farm Organization
Conference / Workshop / Retreat
Veteran / Government Organization
Other
FVC Membership Agreement
I agree to the terms and conditions of FVC Membership. "
http://www.farmvetco.org/about-us/membership/terms-conditions/
"
You will automatically be added to our email list when you click Submit. If you live in a state with a Farmer Veteran Coalition Chapter, your state chapter's president may also contact you.
Thank you!
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