Kansas River Valley Foods

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Kansas River Valley Foods Website Member-Producer Registration

Thank you for your interest in becoming a producer member of Kansas River Valley Foods website. Kansas River Valley Foods website customers and producers are interested in local foods and products produced with sustainable practices that demonstrate good stewardship of the environment. Upon approval, this form will register you to sell products within the Kansas River Valley Foods website. Please fill out and submit the form below.

Any information submitted will be available to the public on your information webpage through this website.

SECTION 1: GENERAL INFORMATION
First Name:	Last Name:
First Name 2:	Last Name 2:
Producer ID: **	Business Name:
** Choose a 5 letter or number Producer ID to represent your operation.
Address:	City:
State:	Zip:
County:	Phone:
E-mail:
Website: http://
How You Heard:
If other, please specify:
YES! I'm interested in volunteering.
SECTION 2: PRODUCTS & PRACTICES
List what you intend to sell through Kansas River Valley Foods. (if applicable) (e.g. meats, grains, jellies, crafts; also note if you have any heritage breeds)

Describe your farming, processing and/or crafting practices. (if applicable)

Describe your pest and disease management system. (if applicable)

Describe your feeding practices. (if applicable) (grass-fed only, free-range, feed-lot, etc.)

Describe your soil and nutrient management. (if applicable) (Do you compost, use fertilizers, green manures or animal manures?)

Describe your water usage practices. (if applicable) (If you irrigate, describe how - e.g. deep well, surface water, etc., and explain how you conserve water or use best management practices. Describe how you are protecting your water source from contamination/erosion).

Describe your conservation/land stewardship practices. (if applicable) (e.g., do you plant windbreaks, maintain grass waterways, riparian buffers, use green manures for wind erosion, plant habitats for birds, improve soil quality, etc.)

Describe any additional information and/or sustainable practices about your operation that would be helpful to a potential customer in understanding your farm or operation better. (e.g. if you are raising any heritage animals you might list breeds or list varieties of heirloom seeds. List the percentage of Kansas ingredients in your processed items).

List your food liability insurance coverage, both general and product-related, as well as any licenses and tests that you have available. (if applicable)

SECTION 3: ORGANIC PRODUCERS
List which products you are selling as organic. (if applicable)

List certifying agency’s name and address: (if applicable)

Certifying Agency's Phone: (if applicable)
Certifying Agency's Fax: (if applicable)
Do you have available for inspection a copy of your current organic certificate? (if applicable)		Yes No
I affirm that all statements made about my farm and products in this application are true, correct and complete and I have given a truthful representation of my operation, practices, and origin of products. If I stated my operation is organic, then I am complying with the National Organic Program and will provide upon request a copy of my certification. I agree
LIABILITY WAIVER STATEMENT
NOTICE: The purpose of this website is solely to serve as a connection tool for local farmers and institutional food providers. By providing this website K-State nor the Kansas Rural Center in no way assumes responsibility for any transactions or any matters arising out of any transactions made possible or facilitated by this website, including but not limited to matters such as payment, delivery, or quality of services or products. K-State nor the Kansas Rural Center handles, inspects nor promotes any produce that may be the subject of any such transactions and does not guarantee the quality, safety, delivery, price or any other aspect of any produce or other products bought or sold through this website or as a result of information obtained on this website. By using this website all users acknowledge that they understand and accept this disclaimer of liability, and in consideration of using this website all users assume all risks and responsibilities involved and they waive any and all claims, grievances and causes of action, including claims for negligence, against K-State, the Kansas Rural Center, the State of Kansas, or their agents and employees. I agree
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Pete Garfinkel, MSW, Local Foods Liaison
1606 Throckmorton Plant Science Center, Manhattan, KS 66506
785-313-4033 info@kansasrivervalley.com