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Member #:

					Grass Farm Name:
					
					Contact Name:
					
					Phone:
					
					Email Address:
					
					Website:
					
			Are You AGA Certified?:
					
							Yes
							No
             				
					Do you want us to contact you about becoming an AGA Certified Producer ?
							Yes
							No	
					
					Other Certifications (Animal Welfare Approved, USDA Organic, etc.):

Information About Your Farm (Limit 1,000 Characters):

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