Guidebook for Certification Request Form

Please complete the information requested. We use this information to get to know you a bit better, so we can create resources and events that meet your needs. We do not share any information with others. Your privacy is important to us. You can read our privacy policy here.

First Name:

Last Name:

Farm/Business Name:


City, State, Zip:


Alternate email (optional):

Telephone Number:

Alternate Telephone Number (optional):

Your Farm/Business Website (optional):

If this is your first request for information/resources from MOSES, please tell us the following:
 Farmer Ag Professional Student Researcher Veteran

If you checked "Farmer," please specify (check all that apply):

 Certified Organic
 Transitioning to Organic

Number of acres you farm:

Check if you would like to receive notice about events for:
 New Organic Stewards (farming 5 years or less) Rural Women's Project

MOSES produces other publications you might like. Check which you’d like to receive:
 Organic Link eNews (monthly email)
 Organic Broadcaster (online edition -- email notice)
 Organic Broadcaster (print edition by mail)
 MOSES Conference Registration Guide (mailed late November)

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