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WG Science Nexus Program Application
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Contact Information
(Required.)
Name
*
Company
*
Current Title
*
City/Town
State/Province
Email Address
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Phone Number
*
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Is your company a Western Growers member?
(Required.)
Yes
No
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Are you willing to commit to 3-5 hours every month for at least one year?
(Required.)
Yes
No
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Is your company/manager in support of your participation in this program?
(Required.)
Yes
No
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Years of professional experience in the agriculture industry:
(Required.)
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Please identify which role you would like to be considered for in the mentorship program:
(Please note the Mentorship Portion of this Program is optional)
(Required.)
Mentor
Protégé
Both
Not Interested
Why are you interested in the program?
Were you previously a part of the WG Science Nexus Program?
Yes
No
Do you have any additional comments, feedback, or questions for the WG Science team?
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Please read the following statement:
By completing this application form, you agree to the goals and purpose of the WG Science Nexus program. Western Growers encourages an open exchange of information and ideas between members participating in the program. However, Western Growers/WG Science cannot and does not review such communications and does not guarantee or endorse the accuracy of any information exchanged between mentors and protégés. You agree that you will participate in the WG Science program in a manner consistent with the WG Science Mission. You further agree to completely release Western Growers/WG Science, and its directors, from all claims, judgements, demands, liabilities, and actions that you may have arising out of, or in any way relating to, your participation in the program.
Western Growers and WG Science does not and shall not discriminate on the basis of race, color, religion, gender, gender expression, age, national origin, disability, marital status, sexual orientation, or military status, in any of its activities or operations.
(Required.)
I agree with the above terms, conditions, and goals of the WG Science Nexus program.
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Electronic Signature
(Required.)
Full Name
Date
