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* 1. Name:

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* 2. Organization & Role:

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* 3. Town & County:

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* 4. Best way to contact you:

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* 5. Which content area are you most interested in?

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* 6. What types of content would you most like to see the Summit focusing on?

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* 7. In what ways would you like to assist in the Summit planning process?

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* 8. What type of time commitment could you make to Summit planning?

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* 9. Is there anyone else that you think should be involved in planning and/or facilitating the North Country Food Justice Summit?

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* 10. Do you have any other comments, concerns, or ideas to share?

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