2009 Conference Registration Form

Alcorn State University Extension Program and the Mississippi Association of Cooperatives 17th Annual Small Farmers Conference 2009 Registration

Agriculture… Sustaining A Legacy For Life March 30- April 1, 2009 ♦ Jackson, Mississippi Name(s): _______________________________________________________________ ______________________________________________________________ Address: _______________________________________________________________ City: __________________________ State: _____________ Zip: _______________ Phone: _________________________ Email address: _________________________ Please fill in all that apply: Professionals, Agencies, Others

_____ ($175) ____$200 (After 2/28/09)

Farmers, Women in Business (per person) ____ ($35) per person Couples _____($50) Per Couple Total Conference Registration

_____ _____ _____

$__________

Learning site preference: Artificial Insemination Value Added Marketing Forestry 101 Coop Development FSA Vendors Borrowers Training Private Chemical Pesticide Certification Women in Business Please submit registration form with enclosed fee made payable to: ASU Small Farmers Conference 2009 233 E. Hamilton Street ♦ Jackson MS 39202 Or register online at: www.smallfarmersconference.com Note: Speakers are exempt from registration. SORRY NO REFUNDS. For more information contact Myra C. Bryant at 601-354-2750.

A Conference on the Move!