Wufoo

Agriculture & Food Systems In-service Registration

This is the registration form that must be filled out if you plan on attending part or all of the annual November Agriculture and Food System In-service

Last Name *
First Name *
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Title *
Cornell Affiliation

If you are a Cornell University or CCE Association employee, please choose the most appropriate option from this list.
Non-Cornell Affiliation

If you are NOT a Cornell University, Cornell Affiliate or CCE Association employee, please specify your employer or company that you are representing.
Email *
Office Phone Number * ### - ### - ####
Please enter a day time phone number where you can be reached
Office Fax Number ### - ### - ####
Special Needs

Please tell us about any special dietary or mobility needs you have so we can make the conference accessible to you.
Emergency Contact

Name of a person we should contact in case of an emergency
Emergency Contact Phone ### - ### - ####
Payment Method

If you want your registration fee charged to your Cornell Account enter the first 7 digits of your account in the space below.
If you are paying by check type the word "CHECK" in this box.
Account Number or "CHECK" *

If you are paying by check after submitting the form, print out your confirmation and send it along with your check made out to Cornell University to Ag In-service, 382 Roberts Hall, Ithaca NY 14850
Registration Option *

You may register for the entire conference, or just one or two days. If you are presenting at the conference but will not be staying for any of the breaks or meals, please select the "Presenter, No Fee" options. Students, please select one of the reduced cost Student options.
TUESDAY WORKSHOP SELECTIONS - Please select only one workshop in each time period
Workshop: Tuesday from 8:00 to 10:00AM
Workshop: Tuesday from 10:30AM - Noon
Workshop: Tuesday from 1:30-3:00PM
Workshop: Tuesday from 3:30-5:00PM
TUESDAY EVENING ACTIVITIES AND WORKSHOP

Here is where you sign up for the NYSACAA Spaghetti Dinner and PMEP Training Session
Activity 1: Will you be attending the NYSACAA Spaghetti Dinner
Yes - Add $17.00 No
Activity 2: Will you attend thePMEP Training Session from 7:30-9:30PM
YES NO

There is no additional charge to attend this training.
WEDNESDAY WORKSHOP SELECTION- Please select only one workshop per time period. If you are taking the dairy off-site workshop today you will need to sign up for all four of the sessions.
Activity 3: NYSACAA Breakfast and Business Meeting Sign UP
Yes, I will attend, bill me an additional $12.00 No, I will not attend
Workshop: Wednesday from 8:00AM to 10:00AM
Workshop: Wednesday from 10:30AM to Noon
Workshop: Wednesday from 1:30 to 3:00PM
Workshop: Wednesday from 3:30 to 5:00PM
THURSDAY WORKSHOP SELECTION- Please select only one workshop per time period.
Workshop: Thursday from 8:00 to 10:00AM
Workshop: Thursday from 10:30AM to Noon
Workshop: Thursday from 1:30 to 3:00PM
Workshop: Thursday from 3:30-5:00PM
Do Not Fill This Out

Wufoo

Agriculture & Food Systems In-service Registration

Payment Method

TUESDAY WORKSHOP SELECTIONS - Please select only one workshop in each time period

TUESDAY EVENING ACTIVITIES AND WORKSHOP

WEDNESDAY WORKSHOP SELECTION- Please select only one workshop per time period. If you are taking the dairy off-site workshop today you will need to sign up for all four of the sessions.

THURSDAY WORKSHOP SELECTION- Please select only one workshop per time period.