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*
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*

I Agree
Should be Empty: