Madera Nitrogen and Irrigation Initiative Workshop

✻ = Required

First Name ✻

Last Name ✻

E-mail address ✻

What counties do you farm in?

Orchard crops grown

If you are a grower in Kern, Fresno, Madera, Merced, Stanislaus, or San Joaquin county, you can request one-on-one assistance from a farm advisor or their staff?

Would you like to sign up for one-on-one irrigation help with a local county advisor or their staff?

Yes No

If so, which county?

Kern Fresno Madera/Merced Stanislaus/San Joaquin

The following information is optional. It is confidential. It is requested to help us document that UC Cooperative Extension is extending services and benefits to everyone who is interested and does not discriminate.

What is your gender?

Man Woman Nonbinary Gender identity not listed Prefer not to state

Are you Hispanic or Latino? (Hispanic or Latino: a person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)

Yes I am Hispanic or Latino No I am not Hispanic or Latino Prefer not to state

What is your race? (check all that apply)

AMERICAN INDIAN OR ALASKA NATIVE: a person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. ASIAN: a person having origins in any of the original peoples of the Far East Southeast Asia or the Indian subcontinent including for example Cambodia China India Japan Korea Malaysia Pakistan the Philippine Islands Thailand and Vietnam. BLACK OR AFRICAN AMERICAN: a person having origins in any of the black racial groups of Africa. NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER: a person having origins in any of the original peoples of Hawaii Guam Samoa or other Pacific Islands. WHITE: a person having origins in any of the original peoples of Europe the Middle East or North Africa. Race not listed Prefer not to state