Wufoo
Food Sovereignty through Farmer Solidarity
Brisbane, June 27 & 28
Expression of Interest Form
Please take a little bit of time to answer all the questions below. We look forward to reading your expression of interest.
PERSONAL DETAILS
Privacy note: We use these details for internal review and communication purposes only; we will never sell your information to a third party.
Name
*
First
Last
Email
*
Best Phone Number to get you on
*
Gender
*
Female
select from drop down list
Male
Town / Suburb
*
Primary Role?
*
Age
*
20 & under
select from drop down list
20-40
Over 40
If you aren't a farmer, please tell us what you do.
*
Maximum Allowed:
50
characters.
Currently Used:
0
characters.
TELL US ABOUT YOURSELF
Privacy note: We use these details for internal review and communication purposes only; we will never sell your information to a third party.
What are you passionate about?
Maximum Allowed:
140
characters.
Currently Used:
0
characters.
What do we need to know about you that we didn't ask?
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140
characters.
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0
characters.
List at least one website that will help us understand you better.
Website
Website
A FEW MORE DETAILS
Terms of Attendance
I agree if I am selected to attend, I am happy to pay $25 reg, will show up and not allow for someone who would like to have been there to miss out.
Please indicate if you are interested in joining the LVC Delegation on the Family Farming Futures Bus for a tour of selected farms on Day 2, Monday 28 June (8am-4pm)
You betcha!
Would you like us to Billet you out in Brisbane with one of Food Connects 'City Cousins'
Yes please
Do Not Fill This Out
Wufoo
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