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Cooperative Extension

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Maine AgrAbility Farm Safety Sticker Request

First Name   

Last Name   

Farm Name   

Mailing Address   

Town      State      Zip   

Home Phone   Cell phone


County              # of requested stickers (5 maximum)

     # of working tractors                   # of different tractor operators                      

Farm Activities:
Check all that apply

fruit/vegetable crops

poultry  field/grain crops
hay        nursery crops dairy
specialized crops livestock orchard crops
agribusiness other