1.Do you farm as an occupation?

Full- time 

Part-Time 

Not at all 

2.Did you experience a illness or injury that changed your life?

Yes 

No 

3.If you answered yes to Question #2, would you be willing to share your story with other women farmers? 

Yes

No 

4.Please tell us a little about your experience in 3-4 sentences.

5.Which state do you reside?

6.Thank you for sharing your story.  If you'd like for us to contact you, please leave your details below.

Name 

Phone Number

Email 

Best Contact Day and Time 

Time Zone