Request a Free Sticker - Maine AgrAbility - University of Maine Cooperative Extension

Name*

First Last

Farm Name

Address*

Street Address City State ZIP Code

Phone

E-mail

Enter Email Confirm Email

County*

Check the stickers you want to receive.

Number of Work Safely: Keep Farming stickers you want to receive:*

(5 Maximum)

Number of Work Safely: Keep Fishing stickers you want to receive:*

(5 Maximum)

Number of Work Safely: Keep Logging stickers you want to receive:*

(5 Maximum)

Number of Farm Strong stickers you want to receive:*

(5 Maximum)

Number of Gasoline Only stickers you want to receive:*

(5 Maximum)

Number of Diesel Only stickers you want to receive:*

(5 Maximum)

Number of working tractors

Number of different tractor operators

Farm Activities

Check all that apply.

If other, please describe:

Name

This field is for validation purposes and should be left unchanged.