Update My Info Step 1 of 2 50% Contact InfoMembership Number*Name* First Name Middle Name Last Name Birthdate MM slash DD slash YYYY Spouse's NameSpouse's Birthdate MM slash DD slash YYYY Email* County*- Select -FairfieldLitchfieldNew HavenTollandHartfordMiddlesexNew LondonWindhamOut of StatePrimary Phone*Work PhoneCell PhoneAddress* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Code This field is hidden when viewing the formTownship(s) you are located in Farm InfoFarm NameSize of Farm Operation- Select -SmallMid-SizeLargeCommodities Produced Dairy Fruit Grains Hay Horses Livestock Poultry Vegetables Other Please Specify Political Party Democrat Republican Independent Comments or Requests I would like to withdraw from the Membership Auto-Renewal program CAPTCHA
