Please enter in the following information in order to be considered for FoodSHIELD membership.

Note: Items with an asterisk (*) require a response.

Your Information

Please provide us with your organizational placement (i.e. State Department of Agriculture - Division of Food - Food Safety Team). We will use this information to build an organizational structure in our AgencyDIR.

Please provide the name and e-mail of the person who referred you to FoodSHIELD. If you heard about FoodSHIELD at a conference please state which conference.

Your Work

If not listed, enter state here: