BioRegen Hemp Crop Registration

2018 Growers Hemp Crop Registration

Register your crop to learn more about available market contracts.
Before filling out the application, please read over the entirety of the form to prepare all the necessary documents.

***All documents shared are confidential and your private information will not be sold or shared. Registration of your grow is the first step in identifying available industrial hemp crop inventories available to fill market contracts. We are fellow farmers and growers of industrial hemp under state license and believe our collective efforts will generate higher returns per acre of hemp grown for you.***

You will need to provide:

1. A PDF or copy of your Industrial Hemp License

2. GPS coordinates of 2018 grow

3. COA (Certificate of Analysis) of parent material (Seeds, Clones, Mother Plants)

WHY DO I NEED TO REGISTER MY 2018 GROW?

You have expressed interest in learning more about ways to market your 2018 industrial hemp crop! We want to help you succeed and in order to succeed, it is important to have correct and complete documentation as required by State and Federal laws. By registering, you are beginning the process of collecting required documentation now versus learning you do not have the correct documentation later at time of sale.

PREREQUISITES (Items you must acknowledge.)

1. You are 18 years of age or older.

2. You are licensed in the state to grow industrial hemp.

3. You are prepared to obtain a Pre-Harvest COA on your industrial hemp crop indicating the Delta-9 THC is not greater than 0.3%

DIRECTIONS FOR COMPLETING THIS APPLICATION

Please complete the following sections to the best of your ability. Once your completed application is received, it will be reviewed and you will be notified of your status in the application process and next steps. Applications will be reviewed on a first come first served basis.
General Information

Farmer contact information
ENTER REFERRAL *
Type the person or organization name referring you to us!
First Name: *
Last Name: *
Date of Birth *

Month Day Year
Industrial Hemp Type: *

Fiber Biomass and/or Flower (CBD) Grain for oil production
Are you currently growing hemp?: *

Yes No

Mailing Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Farm Address (if different from above)

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone

Area Code Phone Number
Mobile Phone *

Area Code Phone Number
Email address *
Contact Information for Hemp License Holder

Complete this section if you are growing hemp under someone else's license. Re-enter your contact information if your name is printed on the hemp license.
Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Daytime Phone

Area Code Phone Number
Evening Phone

Area Code Phone Number
E-mail
Secondary Contact Information

Enter a secondary contact for a farm superintendent or grow partner.
Full Name

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Daytime Phone

Area Code Phone Number
Evening Phone

Area Code Phone Number
E-mail
Hemp Details
Variety/Cultivar Planted *
Plant Date *

Month Day Year
Harvest Date *

Month Day Year
Farm or Field 1

Enter location details of hemp grow
Address *
City, State, ZIP *
Anticipated Harvest Date *

Month Day Year
Number of plants planted: *
Number of plants harvested: *
Pounds of biomass: *
Biomass packaging: *

Super Sacks/Totes Tobacco boxes
Biomass type: *

Whole Plant, Dried Shucked Milled Flower only
Farm or Field 2

Enter location details of hemp grow if you have multiple field locations
Address
City, State, ZIP
Anticipated Harvest Date

Month Day Year
Number of plants planted:
Number of plants to be harvested:
Previous Volunteer & Work Experience
Farm Entity Name

Fill out if hemp payments will be made to a business entity.
Name of Organization
Your Title
Accounts Payable Contact Name:
AP Email
Attach current IRS Form W-9 *
Attachment -Hemp License Copy
Full Name

First Name Last Name
Upload Hemp License Copy Here: *
Upload Dept of Agriculture Letter Copy Here:
Upload Hemp COA Copy Here: *
Attachment -State Driver's License Copy
Full Name

First Name Last Name
Upload Driver's License copy here:
Application Questions
Have you applied for a scholarship or grant to fund your trip with us?

Yes No
If yes, please provide details of the scholarship or grant:
Full Name

First Name Last Name
2018 Harvest Coordinator Contact Information:
E-mail
Phone Number

Area Code Phone Number
Preferred dates
Earliest possible harvest date

Month Day Year
Latest possible harvest date

Month Day Year
Describe your grow and capacity to dry hemp plants. If you do not have drying capacity please write how plants will be harvested and supplied. *
ESSAYS
1.
In the following section, please describe some of the following characteristics you may possess that can be effective in the placement process. We like to use this information to best determine maximum effectiveness of your time during the Service Program, and match your strengths to our needs. For example, you may include one, some, or all of the following. You may also upload additional information as a separate document.
1. Describe some of your strengths and/or weaknesses.
2. What hobbies do you enjoy? (i.e. knitting, photography, sports, physical activities)
3. Is there anything education-related or operations-related in which you excel?
4. If you led a professional development session for the staff, what would you choose to focus on?
5. Do you have language skills, educational training, experience working with kids, low-income populations?
6. Do you have database or specialized technical experience?
Please copy and paste your essay here:
2.
Please use the following space to tell us about your achievements or any other relevant information you would like to convey to the Taktse Resource Coordinator or staff at the Taktse Service Program. This is optional, but encouraged.
Please use the following space to tell us about your achievements or any other relevant information you would like to convey to the Taktse Resource Coordinator or staff at the Taktse Service Program. This is optional, but encouraged.
Please copy and paste your essay here:
3.
Please use the following space to tell us what you wish to accomplish during your gap year, either personally, socially, or academically. How does a fellowship at Taktse fit into your plans?
Please copy and paste your essay here:
Please Upload a Cover Letter
Please Upload a Resume
MEDICAL INFORMATION
Please upload the following:

1. A word document or pdf with a list of medications you currently take and their purposes. Include any and all medical conditions and/or allergies, or any reasons why you would not be fit to travel freely in the Himalayas. Keep in mind Taktse International School is at an altitutde of 6,000 feet.

2. Please upload a written permission from your doctor approving your health to travel to the Himalayas.
1. List of medical conditions and medications
2. Written permission from your doctor
Medical Insurance Provider:
Travel Insurance Provider:
**Any and all medication information will be kept strictly confidential by Taktse Resource Coordinator. Medical information will only be shared under emergency conditions to an appropriate emergency care provider.
BACKGROUND CHECK AGREEMENT
Full Name

First Name Last Name
Social Security Number
Taktse International School Service Program may conduct a criminal history investigation through the Massachusetts Bureau of Investigation. Although a criminal conviction is not an automatic bar to participation, withholding or failing to disclose requested information may disqualify the applicant for consideration.
I hereby declare that:

I have never been convicted of any felony or misdemeanor involving a child I have been convicted of a felony or misdemeanor involving a child
I hereby state that I have not ever been dismissed or resigned from employment or volunteerism following an allegation of unlawful behavior involving a child and consent TISSP to conduct a background screening for criminal history arrest through the Massachusetts Board of Investigation.
Today's Date

Month Day Year
PHOTO CONSENT FORM
I hereby grant to the Taktse International School Service Program and to its representatives, employees, agents unrestricted rights to photograph or record me and use the photo(s) or recording(s) or any other digital production of me for publication processes whether in electronic, print, digital, or electronic publishing format. I release Taktse International School and its directors, board members, employees, legal representatives from all claims, actions, and liabilities related to use of said photographs or recordings.
Today's Date

Month Day Year
VOLUNTEER CODE OF CONDUCT
Volunteers will demonstrate a commitment to the Taktse International School Service Program mission at all times.

Volunteers shall not abuse students or staff in any way. Abuse of any kind is cause for immediate dismissal from the TISSP.

Volunteers will respond to students and staff with respect, consideration, and fair treatment regardless of sex, race, religion, culture, economic level of the family or disability.

Volunteers must appear neat, clean, and appropriately attired according to cultural norms. This includes time spent in town, exercising, and acting as a representative of Taktse International School.

Volunteers must not reveal confidential information about students, families, or other volunteers, unless required by law.

Profanity, inappropriate jokes, sharing inappropriate details of one’s personal life, and any kind of harassment in the presence of students, parents, staff, or other volunteers is prohibited.

Volunteers will portray a positive role model for students by maintaining an attitude of loyalty, patience, courtesy, tact, and maturity.

Volunteers should not give gifts to students, staff, or families. If unusual or unique circumstances arise, please refer to Principal Lauenstein for appropriate advice.

Volunteers should not use photos of the school or of the students for personal gain.

Volunteers that use social media and networking sites should not "friend" students if their profile contains adult or inappropriate language.

Volunteers will act in a caring, honest, respectful, and responsible manner consistent with the mission of TISSP.

Volunteers will not deliberately disobey explicit instructions given by the Taktse Resource Coordinator; lack of obedience may result in volunteer terminator or risk the entire survival of TISSP.

Volunteers should keep in mind that any relationship they have with members of the Taktse International School community should be consistent with this code of conduct.

I understand the above list is not exhaustive, but are examples of expected codes of conduct. Any conduct believed to be inappropriate is grounds for immediate dismissal. I agree to follow the above code of conduct at all times during my participation in TISSP.
Today's Date

Month Day Year
IMPORTANT INFORMATION
**Please review and print for your records**
Acknowledgements:

You agree this 2018 Hemp Crop Registration Program application and agreement is not a purchase order or sales contract.

You agree your participation and crop registration is voluntary.

You agree to follow rules and laws.

You agree this 2018 Hemp Crop Registration Program application and agreement is construed under the laws of North Carolina, USA.

You agree that this application and agreement is to be construed broadly to provide a release, indemnification and waiver to the maximum extent permissible under applicable law.
Today's Date *

Month Day Year
Application Fee - Registration is Free!
Program Fee
Upon acceptance, you will have to pay the program fee. Please indicate here if you wish to apply to waive the fee if you are accepted. Please briefly provide reasons for the need to waive the fee here. Upon acceptance, you will be given another application to fill out.
FINAL STEPS!
Enter the message as it's shown *
We will contact you!

Once your completed application is received and approved, a meeting invite will be sent to you. Thank you for your interest!
Should be Empty:

2018 Growers Hemp Crop Registration

General Information

Contact Information for Hemp License Holder

Secondary Contact Information

Hemp Details

Farm or Field 1

Farm or Field 2

Previous Volunteer & Work Experience

Farm Entity Name

Attachment -Hemp License Copy

Attachment -State Driver's License Copy

Application Questions

ESSAYS

1.

2.

3.

MEDICAL INFORMATION

BACKGROUND CHECK AGREEMENT

PHOTO CONSENT FORM

VOLUNTEER CODE OF CONDUCT

IMPORTANT INFORMATION

**Please review and print for your records**

Application Fee - Registration is Free!

Program Fee

FINAL STEPS!

Please review and print for your records