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Affiliation to Agriculture* Select Full-time/part-time farmer/producerFarmland ownerNon-farmer, but work professionally within the agricultural industryAgriculture student between the ages of 18-24Not affiliated with the agricultural industry, but support the mission of the Ohio Farm Bureau

Prefix Select DrMissMrMrsMs

First Name*

Last Name*

Suffix None C.P.A.D.D.S.Esq.IIIIIIIVJrM.D.M.S.PhDSrV

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Address 1*

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City*

State* Select AlabamaAlaskaAlbertaArizonaArkansasArmed Forces in Europe, the Middle East, Africa, and CanadaArmed Forces in the Americas excluding CanadaArmed Forces in the PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin Islands, USVirginiaWashingtonWest VirginiaWisconsinWyomingYukon

Zip Code*

County* Select AdamsAllenAshlandAshtabulaAthensAuglaizeBelmontBrownButlerCarrollChampaignClarkClermontClintonColumbianaCoshoctonCrawfordCuyahogaDarkeDefianceDelawareErieFairfieldFayetteFranklinFultonGalliaGeaugaGreeneGuernseyHamiltonHancockHardinHarrisonHenryHighlandHockingHolmesHuronJacksonJeffersonKnoxLakeLawrenceLickingLoganLorainLucasMadisonMahoningMarionMedinaMeigsMercerMiamiMonroeMontgomeryMorganMorrowMuskingumNobleOttawaOut of StatePauldingPerryPickawayPikePortagePreblePutnamRichlandRossSanduskySciotoSenecaShelbyStarkSummitTrumbullTuscarawasUnionVan WertVintonWarrenWashingtonWayneWilliamsWoodWyandot

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