<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> MAFO Farmworker - MAFO Registration Form

MAFO REGISTRATION

 

Person Responsible for Payment/Agency Contact:
  First Name *:
  Last Name *:
  Job Title:
  Email *:
  Name as it would appear on a badge:
  Company/Organization/Agency *:
  Address Line 1 *:
  Address Line 2:
  City *:
  US State/Canadian Province/Mexico *:
  Zip (Postal Code) *:
  Work Phone *:
  Extension:
  Fax *:
   
Attendee/Person Registering For The Conference:
  First Name *:
  Last Name *:
  Job Title:
  Email *:
  Name as it would appear on a badge:
  Company/Organization/Agency *:
  Address Line 1 *:
  Address Line 2:
  City *:
  US State/Canadian Province/Mexico *:
  Zip (Postal Code) *:
  Work Phone *:
  Extension:
  Fax *:
   
Attendee/Participants Conference Role:
  Attendee/Participant  
  Speaker/Moderator  
  Sponsor  
  Partner  
  Exhibitor  
   
Have you previously attended a MAFO National Farmworker Conference?
  Yes  
  No  
   
What is your position within the organization/agency/business?
  President/Executive Director  
  Finance Department  
  Manager/Coordinator  
  Supervisor  
  Staff Type:  
  Business/Farm Owner  
  Other:  
   
What is your experience level in your current position?
  Beginning (0 - 3 years)  
  Intermediate (3 - 6 years)  
  Experienced (6 - 10 years)  
   
What age group would you categorize yourself in?
  Ages 18 - 25  
  Ages 26 - 30  
  Ages 31 - 36  
  Ages 37 - 40  
  Ages 41 - 45  
  Ages 45 - up  
   
Please check the salary ranges which best describe you?
  $18 - 25,000  
  $25 - 35,000  
  $35 - 45,000  
  $45 - 65,000  
  $65 - 75,000  
  $75 - up  
   

Workshop Track Preference

Indicate your track preference during the conference. Your preferences will help us determine space needed and the audience interest.
  Workforce Solutions  
  Community Asset Building  
  Healthy: Welcoming Communities  
  Education: Issue & Opportunities  
  Immigration  
  Farmers & Ranchers  
   

About Your Organization

What type of organization/agency/business do you represent? (Check all that apply?)
  Non-Profit  
  Faith Based  
  For - profit  
  Federal Government  
  State Government  
  City Government  
  Educational Institute  
   
What is your organization's experience level?
  Beginning (0 - 5 years)  
  Intermediate (6 - 10 years)  
  Experienced (more than 10 years)  
   
What is your organization's focus area(s)? (Check as many as needed?)
  Farmworkers  
  Latinos  
  Rural Latinos  
  Workforce Development  
  Economic Development  
  Immigration  
  Health  
  Housing  
  Education  
  Farming  
  Other