The Practical Tools and Solutions for Sustaining Family Farms Conference

January 19-22, 2006— Hyatt Regency Hotel — Louisville, KY

Fee Waiver Application Form

Please Print Clearly - Must be postmarked by December 1, 2005

Name: ______________________________________________________________________

Mailing Address: ______________________________________________________________

City, State, Zip: _______________________________________________________________

Daytime Phone: ___________________Evening/Weekend Phone:_______________________

E-mail: ______________________________________________________________________

Why do you want to attend this conference and how do you think the conference will benefit you? (Please be specific, use a separate sheet to answer this question.)

• I understand this fee-waiver is for those who would not be able to attend this conference without it.
• I understand that the fee-waiver only covers the cost of the general conference fee and the Saturday night dinner and that I will be responsible for arranging my own travel, lodging, and other meals.
• I understand the fee-waiver does not cover the optional field trips or optional short courses. If I wish to participate, I will register on my own for those.
• I will complete the conference evaluation form and a 6-month survey, as requested.

• I will notify the conference fee waiver coordinator quickly if I cannot attend the conference, so that my fee-waiver can be given to someone else.

Signed: ____________________________________ Date: ____________________________

Thank you for your interest in the Southern Sustainable Agriculture Working Group Conference. We'll be notifying you of our decisions by December 16, 2005. If you have any questions, please contact the SSAWG conference fee waiver coordinator, Laura Lauffer. Phone: 919-542-6067. Email: laural@blast.com

Applications must be postmarked by December 1, 2005.

Mail your application to: Laura Lauffer, 330 Hatley Road, Pittsboro, NC  27312