Enter Registrant Information:

Listening Sessions:
Please select the session(s) that you plan to attend:
	January 7 - McKimmon Center
	January 7 - Farm Bureau
	January 10 - McKimmon
	January 11 - NC Biotechnology Center
	January 24 - Duplin County Extension Office
	January 24 - VGJ Research & Extension Center
	February 6 - Union County Extension
	February 7 - Iredell County Extension Service
	February 8 - Western NC Agricultural Center
	February 8 - Madison County Extension Office
Contact Information:
Your Name: (*Required)
Company/Commodity You Represent:
Street Address:
City, State, Zip:
Email Address: (*Required)
Phone Number: (*Required)
Relationship to CALS/NC State:
	Alumnus/Alumna
	On-Campus Faculty/Staff
	Off-Campus Faculty/Staff
	Commodity Representative
	Corporate Partner
	Community/Civic Leader
	Current Student
	Prospective Student
	Parent of Current Student
	Parent of Prospective Student
	Other (specify below)
Other relationship to CALS/NC State:
Attendee(s) Information (Please list as you would like names to appear on name tags):
Attendee (1) Last Name: (*Required)
Attendee (1) First Name: (*Required)
Attendee (2) Last Name:
Attendee (2) First Name:
Additional Attendees (Please list by "Last Name, First Name" separated by a comma):