AgArts Collective Registration

Please Fill out this Form to Register your Collective

"*" indicates required fields

Name 1*

First Last

Address 1*

Street Address Address Line 2 City State ZIP Code

Phone 1*

Email 1*

Name 2*

First Last

Address 2*

Street Address Address Line 2 City State ZIP Code

Phone 2*

Email 2*

Name 3*

First Last

Address 3*

Street Address Address Line 2 City State ZIP Code

Phone 3*

Email 3*

Location of Group*

City State

Description of your Collective and its Goals (1,500 characters max.)*

Plans to Achieve your Goals (1,500 characters max.)*

This field is for validation purposes and should be left unchanged.