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About Your Group
Individual/Organization/School Name
(required)
Contact Person (First & Last Name)
(required)
Title/Role
(required)
Email
(required)
Phone number
(required)
Mailing Address
Type of Group
(required)
Select one option
School
Youth Program
Community Organization
After-School Program
Family / Individual
Corparate Group
Other:
Number of people/students. Add grade and age range if applicable (i.e. – 20 students, grade 3-4; 5 chaperons, adult)
(required)
Program Interest
(check all that apply)
Garden-to-Table Cooking Workshops
Healthy Families Cooking Nights
Youth Culinary Apprenticeship Program
Cooking for Health Workshops
Cultural Food Exchange Nights
Cooking Demos
Youth “Food Explorers” Camps
Cooking for Teachers & Staff Wellness – Professional Development
Seasonal Community Feasts
Farm Tours
Service Learning
Corporate Engagement
Professional Development
Environmental Education
Gardening & Urban Agriculture
Preferred Program Date(s). (Please provide multiple dates/date ranges) (MM/DD/YYYY)
(required)
Preferred time (Please provide a range of preferred time – I.e., 9am – 4pm)
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