NAME

ADDRESS

CITY

COUNTY

STATE Zip

Phone - -

E-Mail

Check Occupation (check all that apply)

Dairyman

Feed Grower

Tester

Veterinarian

Research/Gov/Ed

Assn/Commission

Supplier/Mfg/Svc

Ad Agency

Other

List Herd Size and Acreage Totals - (all fields must be filled in. Use a zero where you have no acreage)
Cows
Goats
Corn Acreage
Alfalfa Acreage

Please Answer Personal Question below for verification Purposes

What High School did you graduate from?