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<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
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<meta name="GENERATOR" content="Microsoft FrontPage 4.0">
<meta name="ProgId" content="FrontPage.Editor.Document">
<title>Insert logo here</title>
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<body>
<form method="POST" action="cgi-bin/formmail.pl">
<input type="hidden" name="recipient" value="[email protected]">
<table border="0" cellpadding="3" width="100%" height="667">
<tr>
<td width="25%" height="29"></td>
<td valign="top" width="50%" height="29"><p align="center"><img border="0" src="images/agrilogo-small.gif" align="center" width="100" height="111"></p>
<p align="center"><font face="Arial" size="2"><strong>
<img border="0" src="images/argilogo2.gif" width="388" height="46"><br>
1312 Eighteenth Street, N.W., Suite 300<br>
Washington, D.C., 20036</strong></font></p>
<p align="center"><font face="Arial" size="2"><strong>MEMBERSHIP
APPLICATION</strong></font></p>
<p align="center"> </p>
</td>
<td width="25%" height="29"></td>
</tr>
<tr>
<td width="25%" height="3"></td>
<td width="50%" height="3"><font size="3"></font>
<div align="center">
<center><table border="0" cellpadding="3" width="329">
<tr>
<td width="325" colspan="2" bgcolor="#A0CFCF">
<p align="center"><strong><font face="Arial" size="2">Name and
Address</font></strong></p>
</td>
</tr>
<tr>
<td width="125"><font face="Arial" size="2">Organization name: </font></td>
<td width="192"><font face="Arial" size="2"><input type="text" name="OrganizationName" size="20"></font></td>
</tr>
<tr>
<td width="125"><font face="Arial" size="2">Address:</font></td>
<td width="192"><font face="Arial" size="2"><input type="text" name="Address" size="20"></font></td>
</tr>
<tr>
<td width="125"><font face="Arial" size="2">City:</font></td>
<td width="192"><font face="Arial" size="2"><input type="text" name="City" size="20"></font></td>
</tr>
<tr>
<td width="125"><font face="Arial" size="2">State:</font></td>
<td width="192"><font face="Arial" size="2"><input type="text" name="State" size="2"></font></td>
</tr>
<tr>
<td width="125"><font face="Arial" size="2">ZIP Code:</font></td>
<td width="192"><font face="Arial" size="2"><input type="text" name="ZIP" size="9"></font></td>
</tr>
<tr>
<td width="125"><font face="Arial" size="2">Country:</font></td>
<td width="192"><font face="Arial" size="2"><input type="text" name="Country" size="20"></font></td>
</tr>
<tr>
<td width="125"><font face="Arial" size="2">Telephone:</font></td>
<td width="192"><font face="Arial" size="2"><input type="text" name="Telephone" size="20"></font></td>
</tr>
<tr>
<td width="125"><font face="Arial" size="2">Fax:</font></td>
<td width="192"><font face="Arial" size="2"><input type="text" name="Fax" size="20"></font></td>
</tr>
<tr>
<td width="125"><font face="Arial" size="2">E-mail:</font></td>
<td width="192"><font face="Arial" size="2"><input type="text" name="Email" size="20"></font></td>
</tr>
<tr>
<td width="125"><font face="Arial" size="2">Key Contact:</font></td>
<td width="192"><font face="Arial" size="2"><input type="text" name="KeyContact" size="20"></font></td>
</tr>
<tr>
<td width="125"><font face="Arial" size="2">Key Contact's Title:</font></td>
<td width="192"><font face="Arial" size="2"><input type="text" name="KeyContactTitle" size="20"></font></td>
</tr>
</table>
</center>
</div>
<p> </td>
<td width="25%" height="3"></td>
</tr>
<tr>
<td width="25%" height="610"></td>
<td valign="top" width="50%" height="610">
<div align="center">
<center>
<table border="0" cellpadding="3" width="97" height="768">
<tr>
<td width="607" colspan="4" bgcolor="#A0CFCF" height="18">
<p align="center"><strong><font face="Arial" size="2">Expertise
and Objectives</font></strong></p>
</td>
</tr>
<tr>
<td width="607" colspan="4" height="34"><font face="Arial" size="2">In what sector of the
agro-industrial market are you most interested in expanding?</font></td>
</tr>
<tr>
<td width="607" colspan="4" height="81"><font face="Arial" size="2"><textarea rows="3" name="Expanding" cols="44"></textarea></font></td>
</tr>
<tr>
<td width="607" colspan="4" height="18"><font face="Arial" size="2">In which specific subjects is your
organization able to lend expertise?</font></td>
</tr>
<tr>
<td width="38" height="21"><font face="Arial" size="2"><input type="checkbox" name="Aquaculture" value="ON"></font></td>
<td width="264" height="21"><font face="Arial" size="2">Aquaculture/Fisheries</font></td>
<td width="41" height="21"><font face="Arial" size="2"><input type="checkbox" name="Feed" value="ON"></font></td>
<td width="240" height="21"><font face="Arial" size="2">Feed/Seed</font></td>
</tr>
<tr>
<td width="38" height="34"><font face="Arial" size="2"><input type="checkbox" name="AgChemicals" value="ON"></font></td>
<td width="264" height="34"><font face="Arial" size="2">Agchemicals/Fertilizers</font></td>
<td width="41" height="34"><font face="Arial" size="2"><input type="checkbox" name="Finance" value="ON"></font></td>
<td width="240" height="34"><font face="Arial" size="2">Finance/Related
Services</font></td>
</tr>
<tr>
<td width="38" height="34"><font face="Arial" size="2"><input type="checkbox" name="Bakery" value="ON"></font></td>
<td width="264" height="34"><font face="Arial" size="2">Bakery/Grain</font></td>
<td width="41" height="34"><font face="Arial" size="2"><input type="checkbox" name="FoodDistribution" value="ON"></font></td>
<td width="240" height="34"><font face="Arial" size="2">Food
Distribution/Storage</font></td>
</tr>
<tr>
<td width="38" height="21"><font face="Arial" size="2"><input type="checkbox" name="Beverages" value="ON"></font></td>
<td width="264" height="21"><font face="Arial" size="2">Beverages</font></td>
<td width="41" height="21"><font face="Arial" size="2"><input type="checkbox" name="FoodProcessing" value="ON"></font></td>
<td width="240" height="21"><font face="Arial" size="2">Food
Processing</font></td>
</tr>
<tr>
<td width="38" height="40"><font face="Arial" size="2"><input type="checkbox" name="BiogeneticEng" value="ON"></font></td>
<td width="264" height="40"><font face="Arial" size="2">Biogenetic
Engineering</font></td>
<td width="41" height="40"><font face="Arial" size="2"><input type="checkbox" name="Forestry" value="ON"></font></td>
<td width="240" height="40"><font face="Arial" size="2">Forestry</font></td>
</tr>
<tr>
<td width="38" height="11"><font face="Arial" size="2"><input type="checkbox" name="Biomass" value="ON"></font></td>
<td width="264" height="11"><font face="Arial" size="2">Biomass/AgEnergy</font></td>
<td width="41" height="11"><font face="Arial" size="2"><input type="checkbox" name="Fruits" value="ON"></font></td>
<td width="240" height="11"><font face="Arial" size="2">Fruits/Vegetables</font></td>
</tr>
<tr>
<td width="38" height="18"><font face="Arial" size="2"><input type="checkbox" name="Construction" value="ON"></font></td>
<td width="264" height="18"><font face="Arial" size="2">Construction</font></td>
<td width="41" height="18"><font face="Arial" size="2"><input type="checkbox" name="Groceries" value="ON"></font></td>
<td width="240" height="18"><font face="Arial" size="2">General
Groceries</font></td>
</tr>
<tr>
<td width="38" height="18"><font face="Arial" size="2"><input type="checkbox" name="Dairy" value="ON"></font></td>
<td width="264" height="18"><font face="Arial" size="2">Dairy</font></td>
<td width="41" height="18"><font face="Arial" size="2"><input type="checkbox" name="LandReclamation" value="ON"></font></td>
<td width="240" height="18"><font face="Arial" size="2">Land
Reclamation</font></td>
</tr>
<tr>
<td width="38" height="18"><font face="Arial" size="2"><input type="checkbox" name="Equipment" value="ON"></font></td>
<td width="264" height="18"><font face="Arial" size="2">Equipment/Implements</font></td>
<td width="41" height="18"><font face="Arial" size="2"><input type="checkbox" name="Meat" value="ON"></font></td>
<td width="240" height="18"><font face="Arial" size="2">Meat/Poultry</font></td>
</tr>
<tr>
<td width="38" height="18"><font face="Arial" size="2"><input type="checkbox" name="FarmManage" value="ON"></font></td>
<td width="264" height="18"><font face="Arial" size="2">Farm
Management</font></td>
<td width="41" height="18"><font face="Arial" size="2"><input type="checkbox" name="Sweeteners" value="ON"></font></td>
<td width="240" height="18"><font face="Arial" size="2">Sweeteners</font></td>
</tr>
<tr>
<td width="38" height="34"><font face="Arial" size="2"><input type="checkbox" name="FarmMarketing" value="ON"></font></td>
<td width="264" height="34"><font face="Arial" size="2">Farm Product
Marketing</font></td>
<td width="41" height="34"><font face="Arial" size="2"><input type="checkbox" name="Tobacco" value="ON"></font></td>
<td width="240" height="34"><font face="Arial" size="2">Tobacco</font></td>
</tr>
<tr>
<td width="607" colspan="4" height="18"><font face="Arial" size="2">Other:</font></td>
</tr>
<tr>
<td width="607" colspan="4" height="81"><font face="Arial" size="2"><textarea rows="3" name="Other" cols="44"></textarea></font></td>
</tr>
<tr>
<td width="607" colspan="4" height="18"><font face="Arial" size="2">Objective (reason for becoming a
member of The Agribusiness Council):</font></td>
</tr>
<tr>
<td width="607" colspan="4" height="81"><font face="Arial" size="2"><textarea rows="3" name="Objective" cols="44"></textarea></font></td>
</tr>
</table>
</center>
</div>
<p align="center"><font face="Arial" size="2">Please print out and mail
to:</font></p>
<p align="center"><font face="Arial" size="2"><strong>
The Agribusiness Council<br>
1312 Eighteenth Street, N.W., Suite 300<br>
Washington, D.C., 20036</strong></font></p>
<p align="center"><b>or fax to:</b></p>
<p align="center"><font face="Arial" align="center" size="2"><b>
Fax: (202) 887-9178</b></font></p>
<p align="center">
<a href="mailto:[email protected]">
<input type="submit" value="Submit" name="submit"> </a>
<p align="center">
<input type="reset" value="Clear Form">
<p align="center"><font face="Arial" size="2"><br>
</font><img border="0" src="images/agrilogo-small.gif" width="100" height="111"><br>
<font face="Arial" size="2">Home</font></p>
<p> </td>
<td width="25%" height="610"></td>
</tr>
</table>
</body>
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