Florida Farm Bureau Discussion Meet Application

FLORIDA FARM BUREAU
YOUNG FARMER AND RANCHER
2003 DISCUSSION MEET
REGISTRATION AND INFORMATION SHEET

CONTESTANT'S NAME__________________________________________________________________________

SPOUSE'S NAME____________________________________

PHONE NUMBER___________________________

ADDRESS_____________________________________________________________________________________

SEX_____________

AGE______________

DATE OF BIRTH_________________________________________

SOCIAL SECURITY NUMBER_____________________________E-MAIL__________________________________

PLEASE GIVE A SHORT BIOGRAPHICAL SKETCH:

______________________________________________________________________________________________

FARM BUREAU MEMBERSHIP IS IN THE NAME OF_________________________________________________

THE FARM BUREAU MEMBERSHIP NUMBER IS____________________________________________________

I CERTIFY THAT THE ABOVE-NAMED APPLICANT
IS AN ACTIVE FARM BUREAU MEMBER IN GOOD STANDING WITH_____________________________
COUNTY FARM BUREAU.

SIGNED:

_________________________________________
COUNTY PRESIDENT

MAIL TO:
FLORIDA FARM BUREAU FEDERATION
YF&R LEADERSHIP PROGRAM
PO BOX 147030
GAINESVILLE, FL 32614-7030

REGISTRATION FORM MUST BE IN THE STATE OFFICE BY
OCTOBER 1, 2004