< form action = "https://webto.salesforce.com/servlet/servlet.WebToLead?encoding=UTF-8" method = "POST" > < input name = "oid" type = "hidden" value = "00D6g000006wOuu" >
< input name = "retURL" type = "hidden" value = "http://saafon.org/about-us/confirm/" >
< h3 > Join Our Farmer Network < /h3>
We appreciate your interest in joining our network.
Please fill out the form below and one of our state coordinators will be in touch soon.

Fields marked with an * are required.

< label for = "first_name" > First Name *: < /label>

< label for = "last_name" > Last Name *: < /label>

< label for = "email" > Email *: < /label>

< label for = "phone" > Phone *: < /label>

Best Method of Contact: < select id = "00N6g00000RcrtC" title = "Best Method of Contact" name = "00N6g00000RcrtC" >
< option value = "" > –None– < /option> < option value = "Phone" > Phone < /option> < option value = "Email" > Email < /option> < option value = "Either" > Either < /option> < /select>

< input id = "lead_source" name = "lead_source" type = "hidden" value = "Web" >
< input id = "company" name = "company" type = "hidden" value = "Potential Member" >

Farm Name / Org Name: < input id = "00N6g00000Rd9p3" maxlength = "100" name = "00N6g00000Rd9p3" size = "20" type = "text" >

< label for = "street" > Street Address *: < /label>

< label for = "city" > City *: < /label>

< label for = "state" > State *: < /label>

< label for = "zip" > ZipCode *: < /label>

County *: < input id = "00N6g00000Rcrsn" maxlength = "80" name = "00N6g00000Rcrsn" required = "true/" size = "20" type = "text" >

Inquiries About *:
< select id = "00N6g00000RcrtD" title = "Inquiries About" name = "00N6g00000RcrtD" required = "true" >
< option value = "" > –None– < /option> < option value = "Sourcing/Buying" > Sourcing / Buying < /option> < option value = "Membership" > Membership < /option> < option value = "Partnership" > Partnership < /option> < option value = "Looking for Land">Looking for Land < option value = "Farmer Education" > Farmer Education < /option> < option value = "Other" > Other < /option> < /select>

Additional Comments / Messages:
< textarea id = "00N6g00000RcrtR" name = "00N6g00000RcrtR" rows = "10" wrap = "soft" > < /textarea>

Click the Submit Query button to submit your information.

< input name = "submit" type = "submit" >

< /form>