Skip to content
Home
About Us
Handbook
Constitution and By-Laws
Membership
Leadership
Board Meetings
Committee Chairs
Committee Responsibilities
GACAA AM/PIC
Awards
Friend of The County Agent
GACAA Scholarships
GOTCAA
NACAA
Contact Us
Menu
Home
About Us
Handbook
Constitution and By-Laws
Membership
Leadership
Board Meetings
Committee Chairs
Committee Responsibilities
GACAA AM/PIC
Awards
Friend of The County Agent
GACAA Scholarships
GOTCAA
NACAA
Contact Us
Search
Search
Close this search box.
AM/PIC Registration
2023 GACAA AM/PIC Registration
Georgia Association of County Agriculture Agents
PLEASE PRINT THIS FORM BEFORE YOU HIT SUBMIT SO YOU HAVE A COPY.
Name
(Required)
First
Last
Email
(Required)
Enter Email
Confirm Email
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP
Office Phone
(Required)
Cell Phone
Agent Information
County
(Required)
Appling
Atkinson
Bacon
Baker
Baldwin
Banks
Barrow
Bartow
Ben Hill
Berrien
Bibb
Bleckley
Brantley
Brooks
Bryan
Bulloch
Burke
Butts
Calhoun
Camden
Candler
Carroll
Catoosa
Charlton
Chatham
Chattahoochee
Chattooga
Cherokee
Clarke
Clay
Clayton
Clinch
Cobb
Coffee
Colquitt
Columbia
Cook
Coweta
Crawford
Crisp
Dade
Dawson
Decatur
DeKalb
Dodge
Dooly
Dougherty
Douglas
Early
Echols
Effingham
Elbert
Emanuel
Evans
Fannin
Fayette
Floyd
Forsyth
Franklin
Fulton
Gilmer
Glascock
Glynn
Gordon
Grady
Greene
Gwinnett
Habersham
Hall
Hancock
Haralson
Harris
Hart
Heard
Henry
Houston
Irwin
Jackson
Jasper
Jeff Davis
Jefferson
Jenkins
Johnson
Jones
Lamar
Lanier
Laurens
Lee
Liberty
Lincoln
Long
Lowndes
Lumpkin
Macon
Madison
Marion
McDuffie
McIntosh
Meriwether
Miller
Mitchell
Monroe
Montgomery
Morgan
Murray
Muscogee
Newton
Oconee
Oglethorpe
Paulding
Peach
Pickens
Pierce
Pike
Polk
Pulaski
Putnam
Quitman
Rabun
Randolph
Richmond
Rockdale
Schley
Screven
Seminole
Spalding
Stephens
Stewart
Sumter
Talbot
Taliaferro
Tattnall
Taylor
Telfair
Terrell
Thomas
Tift
Toombs
Towns
Treutlen
Troup
Turner
Twiggs
Union
Upson
Walker
Walton
Ware
Warren
Washington
Wayne
Webster
Wheeler
White
Whitfield
Wilcox
Wilkes
Wilkinson
Worth
District
(Required)
Northwest
Northeast
Southwest
Southeast
State Staff
GOTCAA
Meals needed:
(Required)
Monday November 13 - Welcome Dinner
Tuesday November 14 - Breakfast
Tuesday November 14 - Lunch
Tuesday November 14 - Annual Banquet
Wednesday November 15 - Breakfast
Wednesday November 15 - Awards Luncheon
Select All
These meals are included in your conference registration. Please select all that you will be attending.
Vegetarian meals?
Yes
No
There is a box below if there are other dietary restrictions that we need to know.
Activities/Tours
(Required)
Monday November 13 - Golf
Monday November 13 - Skeet shooting
Monday November 13 - Fishing
Tuesday November 14 - Tour 1: Equine
Tuesday November 14 - Tour 2: Agritourism
Tuesday November 14 - Tour 3: Beef cattle
Tuesday November 14 - Tour 4: Ag equipment
Tuesday November 14 - Historic Augusta
None
Please select all that you plan to attend. Some tours have a limit so will be first come first added.
Conference Cost
(Required)
Pay by Card ($135 + $5 Convenience Fee)
Pay by Check ($135)
Tuesday only/Banquet By Card ($60+$5 Convenience Fee)
Tuesday only/Banquet ($60)
A $5 convenience fee is included for paying by credit card.
Final Price
If you are paying by check please print and mail with your payment to: Guy Hancock, GACAA Treasurer, 4602 Research Way, 305 HH Tift Bldg. Tifton, GA 31793-5766
Credit Card
Cardholder Name
Card Details
Any other special needs or requirements (dietary, mobility, physical)? Please indicate in box below.
Email
This field is for validation purposes and should be left unchanged.
