Registration Form

November 2 & 3, 2017 – B Resort and Spa - Lake Buena Vista, Florida
Registration includes both days of programs, lunch, dinner, and continental breakfast.
Complete this online form below or download a Registration Form (PDF) here.
  On or before October 30 After October 30
Full Registration Price: $249.00 each $279.00 each
If registering two or more people: $225.00 each $255.00 each
Professional, Non-Ag Business $299.00 each $319.00 each
Registration Form (Items in bold are required)

Company Name:
List your primary business commodity:
Non-Ag Business will be charged the higher rate.
Grant funding focuses on increasing attendance of young, beginning and small farmers.
Please check if you are any of the following: (Select all that apply)
Young Farmer - Younger than 35 years of age
Beginning Farmer - Less than 10 years in business
Small Farmer - Gross Revenues Less than $250,000
Socially Disadvantaged Farmer - Click Here for more information
    Optional Tour ($25)
Wednesday Nov. 1
Primary Attendee:  
Additional Attendees:  
More than 4 attendees? Please submit multiple registrations.
Payment Information
Card Type:
Credit Card Number:
Expiration Date: /20
CVV: What is a CVV? 
Cardholder's Name:
Cardholder's Phone:
Cardholder's Email: (Required for transaction confirmation)
Credit Card Billing Address:*(If different from that of above)
I authorize FNGLA to process my credit card for the attendee registration(s)
specified on this form.

It is the intention of FNGLA to comply fully with the Americans with Disabilities Act. Anyone planning to attend these programs that have special needs, please make FNGLA aware of these special needs.

Please check here if you require special accommodations to fully participate.
Please check here if you would prefer vegetarian meals.

Cancellations must be in writing before November 1, 2017 to receive 90% refund.
No refunds after November 2, 2017.

REMEMBER! Early pricing registration ends October 30, 2017

For program and event questions, please contact: Regina Thomas or Karen Keene.
For help or questions with registering, please contact: Linda Reindl.

* Enter this Verification Code: 705533