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REGISTRATION FORM
Urban Gardening In-service Training
VSU Randolph Research Farm Pavilion
4415 River Rd, Petersburg, VA 23803
October 25-26, 2022
Name and Contact Information
First Name
Last Name
Email
Unit/Location
Title (ex. Agent, Specialist)
Event to be held at Virginia State University on October 25-26, 2022. What days will you attend?
Event to be held at Virginia State University on October 25-26, 2022. What days will you attend?
YES
NO
Tuesday, October 25
YES
NO
Wednesday, October 26
YES
NO
List Food Allergies or Dietary Restrictions
Please indicate your interest in the following training topics:
Please indicate your interest in the following training topics:
Very Interested
Somewhat Interested
Not Interested
Soil Health and Fertility Management
Very Interested
Somewhat Interested
Not Interested
Insect and Mite Pest Management
Very Interested
Somewhat Interested
Not Interested
Beneficial Insects
Very Interested
Somewhat Interested
Not Interested
Management of Plant Diseases
Very Interested
Somewhat Interested
Not Interested
How to Create and Maintain a Productive Raised-bed Garden
Very Interested
Somewhat Interested
Not Interested
Tour of the Sustainable & Urban Agriculture Demo Site
Very Interested
Somewhat Interested
Not Interested
Small Fruit Production
Very Interested
Somewhat Interested
Not Interested
Weed Management
Very Interested
Somewhat Interested
Not Interested
Vegetable Production Techniques
Very Interested
Somewhat Interested
Not Interested
Produce Marketing
Very Interested
Somewhat Interested
Not Interested
What is your cultural heritage?
White or Caucasian
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
Hispanic or Latino
Prefer not to disclose
What is your age range?
Under 18
19-24
25-34
35-44
45-54
55-64
65 and over
Prefer not to disclose
Are you a U.S. Military Veteran?
Yes
No
Prefer not to disclose
What is your gender?
Male
Female
Non-binary / third gender
Prefer not to disclose
Current Progress 0%
If you have any questions, please contact Dr. Leonard Githinji at lgithinji@vsu.edu
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