REGISTRATION FORM Please fill out this form. You may submit your registration online, or if you prefer, you may print out our registration form and fax or mail that form to us. If you prefer to fill out our registration form offline, you can find a printable version by clicking here. All fields on this form are required. Enter the name as it should exactly be printed on the course completion certificate: Mailing Address: City: State: Zip: Phone number (including area code): Cell phone # (including area code): Last 4 digits of SSN: Email address: Tuition Fee $100.00 Payment is due at registration submission and is non-refundable and non-transferable. If the course is not completed within a calender year, the initial fee is forfet and a new fee of $100.00 must be submitted in order to receive credit and a completion certification for the course. $50.00 for each additional business partner to receive a certificate in their name. NOTE: Each partner must also complete and submit the coursework in order to receive a certificate of completion. How many partners do you wish to include with this registration? 0 (just you = $100.00) 1 (1 + you = $150.00) 2 (2 + you = $200.00) 3 (3 + you = $250.00) 4 (4 + you = $300.00) 5 (5 + you = $350.00) 6+ (contact Karen) Select the option that matches your operation. ** This is the Financial Management Training Program approved by the Farm Service Agency to meet the required Farmer Borrower Training Requirements. This Vendor makes no other claims or warrenties, either stated or implied.** FSA Information State: Dist/County Office: Farm Loan Approval Official: Phone number (including area code first): Fax number (including area code first): Office Mailing Address: City: Zip: NOTE: Submission of this form electronically constitutes appending the signature of the person named on the course completion certificate (the borrower). Successful submission of this registration will take you to the payment options page.