Nominator Info
Your Name
*
First Name
Last Name
About the Farm
Farm Name
*
Farm Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Person
*
First Name
Last Name
Contact Email
your.name@example.com
Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
How many employees (full and part-time) work at the farm?
*
Is this a multi-generational farm?
*
Yes
No
How many years?
*
What type of farm is it?
*
Dairy
Beef
Chicken
Ginseng
Croppers
Other
Upload a Farm Photo
*
Browse Files
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of
Photo Release
*
I hereby grant full permission to the Sponsors, their officers, directors, employees, advertising and promotional agencies, and anyone authorized by any of them to use my name, likeness, voice, photographs, videotaped footage, and biographical data, in whole or in part, in any and all media, for the purpose of advertising, publicity, and trade, and in connection therewith, I hereby release each of them from any and all liability. I agree to the use of my name and likeness for such purposes without limitation and without any compensation whatsoever, except where prohibited by law.
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