Collegiate Discussion Meet Application

Collegiate Discussion Meet Application
Competitor's Name
As it should appear in the program
Phonetic Pronounciation
In case we need help pronouncing your name correctly
College or University
Degree in Progress
Correspondence Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home State
Home County
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Member Number
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Gender
Birth Date

MonthDayYear
Biography
Please write a 5-7 line biographical sketch written in the third person
By checking 'I Agree' I certify that I am the above named applicant, with a membership of a county Farm Bureau in Kansas, and consent to the rules of Kansas Farm Bureau's Young Farmer and Rancher Discussion Meet
Should be Empty: