2025 Federal Affairs Trip Application

2025 Federal Affairs Trip Application

Due: Monday, March 17, 2025
Please complete all the following information and submit the application by March 17, 2025. Unfortunately, no handwritten or paper copies will be accepted. If you are having difficulties with this form, please contact Bailey Fisher at bmfisher@pfb.com.

NOTE: Please expect to walk between 2-3 miles a day. Be honest with yourself because we do not want your walking capabilities to limit your experience in DC.
General/Contact Information
Note: If accepted, we will be calling for additional information such as place of birth and Social Security Number. Due to security concerns, we take personal confidential information over the phone.
Full Legal Name*

First NameLast Name
County Farm Bureau*
FB Position(s) held*

PresidentVice PresidentSecretaryTreasurerCounty Board DirectorGovernment Relations DirectorYAP Committee MemberWomen's Leadership Committee MemberAg Promotion Committee MemberState Legislative CommitteeU.S. Legislative CommitteeOther
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Are you able to show proof of real identification? (i.e., Real ID or passport)*

YesNo
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*

Area CodePhone Number
Email*
example@example.com
Best Method of Contact*
Farm/Business Information
Farm/Business Name
Commodities Produced
Please provide a brief description of your farm/business.*
Legislative Questions
Choose your 119th Congressional Legislative District (2025-2026).*
List your top 3 federal legislative areas of interest.*
Please explain why you would like to go to D.C.*
Trip Questions
Rank order of trip preference:*
First Choice
Rank order of trip preference:*
Second Choice
Please list any federal legislative activity or event you attended in 2024 (district office meeting, town hall, legislative farm tour, legislative breakfast, etc.). If none, please put N/A. *
Requirements to attend: (Check accordingly)*

I have read and understood PFB’s Code of Conduct and Terms of Agreement (scroll to the bottom of this application for both documents) for attending federal affairs trips, and if chosen I agree to signing both documents.I will attend the March 19, 2025 Virtual Legislative Update for the Spring Trip OR I will attend the July 24, 2024 Virtual Legislative Update for the Fall Trip.Completed 75 percent or more of all action requests during the year preceding the visit (includes PFB and AFBF).Attended at least one Congressional event in 2024 (please list above).
Signature*

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Code of Conduct
Terms of Agreement
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2025 Federal Affairs Trip Application

General/Contact Information

Farm/Business Information

Legislative Questions

Trip Questions