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CROP SIGN UP FORM
Legislator name
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State
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Title / in which chamber so you serve?
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Preferred email address
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Additional emails
Staff or scheduler name
Staff or scheduler email
Full Mailing Address
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Best Phone Number
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Can this phone number receive text messages?
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Yes
No
Pronouns
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She/Her/Hers
He/Him/His
They/Their/Theirs
Other
If you answered "other" above and prefer to say, please write pronoun below:
Race
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Asian
Black or African American
Hispanic
Middle Eastern
Native American
Caucasian or White
Native Hawaiian
Pacific Islander
Other
Prefer not to say
If you answered "other" above and prefer to say, please indicate your race below:
When were you first elected to the legislature?
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When are you next up for re-election?
Is your district rural or have a rural component?
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Yes
No
What committees do you serve on?
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Are you in a leadership position and if so, what is that position? If no, please type NA
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Please indicate whether or are in the majority, minority, or are an independent in your state:
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Majority
Minority
Independent
What rural, food, agriculture or environmental issues are you particularly interested in or are working on?
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Which organizations in your state do you look to for information and/or guidance on farm policy?
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Do you feel like you hear the progressive point of view on agricultural policy?
Yes, I do or I know where to find the information.
No, I have no idea where to go to find this information.
Other
How can SiX help you be a champion for progressive agricultural, food and rural policy in your state?
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In this policy space, what should we know about you? Do you come from a rural background? Are you new to the space? Have you done something interesting in your state that other SiX legislators should know about? Please tell us anything pertinent.
Are you interested in joining an issue-focused legislator working group? If yes, please pick from the options below.
Justice for Black farmers and farmer equity
Soil health and regenerative agriculture
Corporate Agribusiness Accountability
Building Progressive Power Through Rural Organizing
How did you hear about the CROP?
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Colleague in the State Legislature
Organizational/Community Partner
Invited by a State Innovation Exchange Staff Member (if so please put their name in the answer space in the next section)
State Innovation Exchange Event (Webinar or Conference)
Other
If you answered 'other' to the above question or were invited by a SiX staff member, please explain below.
What is your Bluesky handle?
What is your Facebook handle?
What is your Instagram handle?
Other social media handles?
