Register for Indiana Grown 1) Register for Indiana Grown-new Legal Business Name * Display Name * The display name will be visible on Indiana Grown's website First Name * Last Name * Phone Number * Email * Please use a business email. This will be featured in our member directory as a means of contacting you. Would you like this phone number to be visible on your public profile? * Yes No Would you like this email to be visible on your public profile? * Yes No Are there any additional emails we should send announcements to? Please separate multiple emails by comma. Physical Address * Physical Address Physical Address Physical Address Physical Address Physical Address Physical State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Physical Address County * Please include only county name, i.e., "Hamilton." For counties outside of Indiana, please use "Outside Indiana" Is this location open to the public? * Yes No Mailing Address * Mailing Address <span style="font-weight:700;color:#B94A48;font-size:15px;">*</span> Mailing Address <span style="font-weight:700;color:#B94A48;font-size:15px;">*</span> Mailing Address <span style="font-weight:700;color:#B94A48;font-size:15px;">*</span> Mailing Address <span style="font-weight:700;color:#B94A48;font-size:15px;">*</span> Mailing Address <span style="font-weight:700;color:#B94A48;font-size:15px;">*</span> State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Mailing Address <span style="font-weight:700;color:#B94A48;font-size:15px;">*</span> Select all Categories that best represent the products you sell OR your organization type * Agritourism Animal Fibers/Wool Artisan & Merchandise Body Care & Candles Craft Beverages Crops Farmers Market Food & Beverage Garden Center & Nurseries Hardwood Hemp Derived Product Hydroponics Indiana Grown Partner Livestock Meat Pet Accessories and Treats Processing Facility Produce Restaurant/Food Truck Retailer Seafood Vermiculture Select all Subcategories that apply for your organization * If your product or organization does not fit within any of the above categories, provide more information: What vegetables do you grow? What fruits do you grow? Where is your product sold? * List/Describe all items you sell How many acres do you farm (if actively farming)? Are you currently exporting outside of the U.S. or interested in exporting? Yes, exporting Yes, interested Not interested What 3rd party audits have you completed? How do you distribute your product(s)? - Please Select One or More Options -DistributorSelf-distributed Who is the distributor? Are you a veteran of the Armed Forces? - Please Select One or More Options -NoneArmyNavyMarinesAir ForceNational GuardCoast Guard Are you a home-based vendor (HBV)? Yes No Do you use a commercial kitchen? Yes No Commercial Kitchen Name & Location Do you use a Co-Packer? Yes No What is the Co-Packer name & location? Why are you interested in joining Indiana Grown? Business Website: Business Facebook URL: Business Instagram URL: Description of your business * Upload profile photo Drop a file here or click to upload Choose File Maximum file size: 15MB The following self-identifying questions are voluntary and not required for membership consideration. We request this information to help us better understand and serve our members. Answer the following questions about the primary owner/operator the farm or business listed on this application: What is your race / ethnicity? Asian Black or African American Hispanic/Latino Native American/Alaskan Native Hawaiian/Pacific Islander White Prefer Not to Answer OtherOther Do you want a BIPOC (Black, Indigenous, People of Color) distinction included on your directory profile? Yes No What is the gender with which you primarily identify? Male Female Prefer Not to Answer What is your age? < 18 18-30 31-45 46-55 56-65 66-75 > 75 Prefer Not to Answer Is your business a certified Minority Business Enterprise (MBE)? Yes No N/A Is your business a certified Women-Owned Business Enterprise (WBE)? Yes No N/A Are you a first-generation farmer? Yes No What generation are you? I agree to Indiana Grown's Terms & Conditions * Yes Signature * signature keyboard Clear Captcha Submit If you are human, leave this field blank.
