PFB Federal Affairs Trip Application

Please complete all the following information and submit the form to PFB by December 1, 2018.

*We will be required to provide this information for security clearance.
Personal Information
County Farm Bureau
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Name on Name Tag
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Street Mailing Address
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Home Phone
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Work Phone
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Cell Phone
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Email
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Best Method of Contact
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I agree to allow my contact information to be shared with the other trip attendees.
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*Date of Birth
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*Place of Birth
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Miscellaneous Information
FB Position or Positions Held
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Commodities Produced
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Your Congressman
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Federal Issues of Interest
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Brief Description of Farm/Ag Business
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Please explain why you would like to go to D.C.
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Rank Order of Trip Preference

**Please note: June 11 will be a one-day trip for AFBF's Advocacy Fly-In, with an overnight extension as a possible option.

First Preference
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Second Preference
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Third Preference
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Requirements to Attend (Check accordingly)
#1
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Attend February 2019 Update Meeting for February/June or July Update for September.


#2
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Participate in at least one of the following during year preceding trip to D.C. (other Congressional activities may be considered on a case-by-case basis):


Congressional District Office Meeting
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Legislative Farm Tour
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Congressional Town Hall
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Legislative Breakfast
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Other Congressional Activities
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Other Congressional Activities Dates
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#3
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Complete 75 percent or more of all action requests during the year preceding the visit (includes state, national and regulatory).


#4
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I agree to participate in a phone briefing two weeks before trip (May be waived for February trip depending on sceduling of update meetings.


**Share a Room with Another D.C. Participant
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**To help us manage our costs, our normal practice is to have two participants share a hotel room. If you definitely want a single room, we ask that your county cover the cost difference, which is roughly $145.00/night.

Spouses may attend at the discretion of PFB staff. If a spouse is planning to attend, ½ of room costs, along with meals will be paid by participant or county Farm Bureau.