My Local Cooperative Location Highlight Survey

1. Your First & Last Name *This question is required.

2. City *This question is required.

3. State *This question is required.

4. School Name *This question is required.

5. FFA Chapter Name (if different than school name)

6. Your email address *This question is required.

7. Best Phone Number to Reach You

8. Cooperative Name *This question is required.

9. Cooperative Address

10. Name of Contact at Cooperative *This question is required.

11. Cooperative Contact Phone Number *This question is required.

12. Cooperative Contact Email Address

13. Please share in a few sentences how this local cooperative supports your agriculture program and/or the community in general. *This question is required.

14. Optional - Please share a picture of the cooperative location (the front of the cooperative) or a cooperative representative with FFA members or at a community event.

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15. Optional - Picture Caption(s)

16. Optional - another picture of the cooperative location (the front of the cooperative) or a cooperative representative with FFA members or at a community event.

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17. Optional - Picture Caption(s)

18. Optional - another picture of the cooperative location (the front of the cooperative) or a cooperative representative with FFA members or at a community event.

File: {{filename}} delete

19. Optional - Picture Caption(s)