* 1. How long has your agency been a member of the Mid-Ohio Foodbank?

* 2. Does your program have at least one person with a valid Food Safety Certificate on file?

* 3. Choose a Food Safety Training Date: (Training is held at the Mid-Ohio Foodbank)

* 4. Name of Attendees:(Max 2 per Agency)

* 6. Agency Name:

7. Agency ID Number:

8. County:

* 9. Contact Phone Number:

10. Contact Email:

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