Name
*
First Name
Last Name
Email
*
Please notify me via email of future learning programs & FCI news
Phone Number
County in which you reside
*
Please Select
Alexander
Bond
Calhoun
Cass
Champaign
Christian
Clark
Clay
Clinton
Coles
Crawford
Cumberland
DeWitt
Douglas
Edgar
Edwards
Effingham
Fayette
Ford
Franklin
Gallatin
Greene
Hamilton
Hardin
Iroquois
Jackson
Jasper
Jefferson
Jersey
Johnson
Lawrence
Logan
Macon
Macoupin
Madison
Marion
Massac
Menard
Monroe
Montgomery
Morgan
Moultrie
Perry
Piatt
Pope
Pulaski
Randolph
Richland
Saint Clair
Saline
Sangamon
Scott
Shelby
Union
Vermilion
Wabash
Washington
Wayne
White
Williamson
Other
FCI office where you conduct business
*
Not currently doing business with FCI
Decatur
Effingham
Highland
Jacksonville
Jerseyville
Lawrenceville
Mahomet
Marion
Mt. Vernon
Paris
Red Bud
Sherman
Taylorville
Watseka
Select the Insure with Confidence program you plan to attend
December 11 - Taylorville Regional Office (1155 E 1500 N Road, Taylorville)
December 12 - Marion Regional Office (2601 Henry Drive, Marion)
Which best describes you (choose all that apply)?
Full-time Farmer
Part-time Farmer (off farm career)
FCI Employee
Young or Beginning Farmer (40 years of age or under and/or 10 years or less farming)
Other
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which office or department (for your nametag)
Submit
Should be Empty: