PSA Course Registration Form

Produce Safety Alliance (PSA) Grower Training Registration Form
The training will be held on Sunday, January 18th from 9am-5:30pm at the Kalahari Resort (1305 Kalahari Drive, Wisconsin Dells, WI) as part of the Growing Wisconsin Conference. Onsite registration and material pickup will begin at 8:30am. Participants can expect a full day of training (~8 hours). Lunch will NOT be provided, but 1 hour will be allotted.

This course is free to attend and includes a PSA Grower Training Manual. Participants present and engaged in all modules will be eligible for a PSA/AFDO Certificate of Course Completion. There is a $35 processing fee for the certificate.

The PSA Grower Training is recognized by FDA as one way to satisfy the training requirement of the FSMA Produce Safety Rule, outlined in provision 112.22(c) that requires "At least one supervisor or responsible party for your farm must have successfully completed food safety training at least equivalent to that received under standardized curriculum recognized as adequate by the Food and Drug Administration."
Farm Name*
Farm Address*

Street Address

Street Address Line 2

CityState

Zip Code
Participant Name*

First NameLast Name
E-mail*
example@example.com
Phone Number
What commodities do you grow?
Why are you taking the training? (as a refresher, to obtain certification, etc.)
Do you need any accommodations?
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Produce Safety Alliance (PSA) Grower Training Registration Form