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Care Farming Network National Conference

How many people are you registering? *

Fill in your registration information on this page. You will be able to enter the registration information for additional people after you complete this page and click "Continue".

Registration Fee(s)

If you have a discount code, enter it here

Early Bird Registration Fee(s)

$245.00

Please consider making a donation to contribute to our scholarship fund, which helps make our conference more accessible to all.

$50

$100

$250

$500

$1,000

- none -

Other Donation Amount

Total for this participant

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Individual Information

First Name *

Last Name *

Preferred name (if different from above, to be used for communication and program materials)

Gender Pronouns

she/her

they/them

he/him

other

If you selected "Other" above, please describe here.

Email *

Country *

State *

City / Town *

Zip Code *

Job Title / Role *

Do you identify as a farmer? *

Yes

No

For how many years have you been working in care farming?

Aspiring care farmer

1-3 years

3-5 years

5-10 years

10+ years

N/A

Please let us know which of the following you will be participating in so that we may provide an accurate headcount to our host farm and venue. The cost of tours and meals is included in the registration fee. *

Monday Farm Tour

Monday Dinner/Reception

Tuesday Breakfast

Tuesday Lunch

Tuesday Dinner

Wednesday Breakfast

Wednesday Lunch

Will you need to utilize a shuttle service on Monday? *

Yes (I will not have my own car)

No (I am bringing my own car)

Maybe/Unsure

Shuttles will be provided to and from Prospect Meadow Farm for conference activities on Monday for attendees who do not have their own transportation. To help us plan our shuttle service, please let us know if you will be utilizing the shuttles.

Please share any dietary preferences. *

Pescatarian

Vegetarian (I do not eat fish)

Vegan

Dairy free

Gluten free

Kosher

Halal

Other

None

If you selected "Other" above, please describe here.

Please tell us about any accessibility requirements you have to be able to attend and participate fully in the conference.

For example: priority seating, wheelchair accessibility, specialty devices, sign language interpretation. Please follow this link for other examples of accommodations: https://class.wfu.edu/disability-services/information-for-faculty/example-of-accommodations/#20220509140043

Demographic Questions

We respect human diversity and understand that questions about identity are sensitive and personal. We request the following demographic information to improve the effectiveness and inclusivity of our organization and ensure we address the needs of our entire community.

Which best describes your race/ethnicity? Please check all that apply.

American Indian, Alaska native or First Nations

Asian

Black or African-American

Hispanic or Latinx

Native Hawaiian or Pacific Islander

Middle Eastern or North African

White

Prefer not to say

Prefer to describe

If you selected "Other" above, please describe here.

Do you identify as a person with a disability or other chronic condition?

Yes

No

Prefer not to answer

How would you describe your disability or chronic condition?

Autism

Blind or visually impaired

Deaf or Hard of Hearing

Health-related disability

Intellectual/Developmental Disability

Learning disability

Mental health condition

Mobility-related disability

Speech-related disability

Other

N/A

If you selected "Other" above, please describe here.

Additional Demographics: Is there anything else you would like to share about your identity or background?

Organization Information

Organization

Website URL

The following questions are for care farmers and aspiring care farmers only.

What year was your organization or farm founded? (if aspiring write aspiring)

Which population(s) does your care farm work with? Please select all that apply.

People with Mental Health Challenges

People with Physical Disabilities

People with Intellectual Disabilities

People in Recovery from Substance Abuse

People with Chronic Health Conditions

Young People at Risk

Elderly People

Veterans

Those recently incarcerated

Other

If you selected "Other" above, please describe here.

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CARE FARMING NETWORK
A PROGRAM OF RED WIGGLER COMMUNITY FARM.

© Care Farming Network 2024. All rights reserved.

RED WIGGLER COMMUNITY FARM
PO Box 968
Clarksburg, MD 20871