Leadership Academy Application
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
Email
example@example.com
Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid cell phone number.
Applicant biography (3-5 sentences written in third person)
To be used on website, newspaper, and media release if selected.
Briefly describe your connection to agriculture (e.g., crops, livestock, ag business)
Describe your involvement with Farm Bureau
Please list organizations and/or groups you have been a member of and your leadership role in each if applicable
Why are you interested in participating in Leadership Academy? What are your expectations and goals for the program?
What is the most critical issue facing agriculture in the next five to 10 years?
Can you attend all sessions?
If no, please list any conflicts you have:
Submit
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