VITAL 2024 Registration

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Located at Farm Wisconsin Discovery Center on Thursday, April 4th from 9:30 a.m. to 3:00 p.m.

Registration cost: $30 per person before 3.28.24. After 3.29.24 registration cost is $35 per person. Registration fee includes meals, breaks, and materials.

Email *

First Name *

Last Name *

Farm or Business Name

Mailing Address *

City, State ZIP Code *

Telephone Number *

Please indicate any dietary and/or accessibility needs

Please select the option below that best describes your ethnicity. *

I identify as Chicano/Chicana/Chicanx, Hispanic, or Latino/Latinx.

I do not identify as Chicano/Chicana/Chicanx, Hispanic, or Latino/Latinx.

I prefer not to respond.

Please select the option(s) below that best describe your race. Select all that apply. *

Alaska Native, American Indian, Indigenous, or Native American

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

One or more races that are not listed above

I prefer not to respond.

Required

Please select the option below that best describes how you identify. *

Female

Male

Non-binary

I prefer not to respond.

Please select the option below that best describes your age. *

Between 0 and 4 years

Between 5 and 17 years

Between 18 and 24 years

Between 25 and 44 years

Between 45 and 64 years

Between 65 and 74 years

75 years or older

I prefer not to respond.

To pay by credit or debit card, click "Credit/Debit Card Payment" below.

Credit/Debit Card Payment

If paying by check, make it payable to:

Extension Manitowoc County

Mail to:
Manitowoc County SWCD

4319 Expo Dr

PO Box 935

Manitowoc, WI 54221

A 2.20% convenience fee will be charged for Credit or Debit card payments using Visa, MasterCard, etc.

Pay by check by mail

Pay by check at the door

Required

An EEO/Affirmative Action employer, University of Wisconsin-Extension provides equal opportunities in employment and programming, including Title IX and ADA requirements.

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