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First Name:
Last Name:
Organization: (e.g. farm, business, or agency)
Address:
City:
State:
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County:
Home Phone:
Work Phone:
Mobile Phone:
Fax:
Email address:
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I am interested in this program as a:
  Producer
  Distributor
  Buyer
  Customer or Consumer Advocate
  Organization
  Media

I am interested in the following local foods issues:
  Farm to School
  Community Gardens
  Local Distribution Models
  Local access for local products
  Large retailers offering local products
  Food security for those in need
  Agricultural Tourism
  Other
          If "other," please describe here:  

I heard about Local Fare through:
  Local Fare brochure
  Local Fare website
  Friend /word of mouth
  Other
          If "other," please describe here: