Request edit access
2017 Groundswell Participant Registration Form
Register for Groundswell's 2017 Workshops and Courses! Please note, your registration will not be considered complete until you submit your payment via PayPal or personal check (made to CTA-Groundswell).
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Business / Farm name (if any)
Your answer
Our monthly e-newsletter includes up to date regional farming and food info + a calendar of events to help you stay connected to your regional community food system. If you prefer not to be enrolled in our monthly e-news, please mark the box below.
How did you hear about Groundswell's Workshops/Courses? *
Required
Diversity Matters
Groundswell places a high value on attracting diverse trainees to our programs and to creating inclusive program offerings for all. We especially encourage people of color, new Americans, veterans, LGBTQ and other aspiring producers who have sometimes been excluded from the sustainable agriculture/local foods movement. The following demographic information helps us measure our success in reaching out to various segments of our community:
Race & Ethnicity: Which of the following identities do you claim? *
Required
Other aspects of Diversity: *
Required
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms