FALL 2022

NCSPC WEBSITE REQUEST

Please fill out and return this form with your assessment dues if you wish to be listed as a member.

Please check all areas you wish to be listed:  NCSPC Website  SweetPotato Speak Newsletter

Type of Business:

 Grower  Packer/Shipper  Processor/Manufacturer  NC Certified Seed Producer

Contact Information (Primary Contact for NCSPC)

Company Name: Address (please incude city state and zip) Contact Person Phone

Fax

Main Contact E-Mail Address Company Website (to be listed on NCSPC site) Additional Personnel to be listed on NCSPC Website/SweetPotato Speak Please list complete information below to ensure we have all points of contact for each person to be listed!

Name/Title Email/Phone (indicate office or cell) Name/Title Email/Phone (indicate office or cell) Name/Title Email/Phone (indicate office or cell) Name/Title Email/Phone (indicate office or cell)

1.

2.

3.

4.

Products

Business Description for NCSPC Website (100 words or less)

You will ONLY be listed with a completed form each year!