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AgriSafe Nurse Scholar Program Group Seat Purchase Form

To purchase group seats for the AgriSafe Nurse Scholar Program, please complete the form below. Once your transaction is processed, you will receive an email from Koby Schexnayder (kschexnayder@agrisafe.org) containing detailed instructions on how to access your purchased seats.

Before completing your purchase, please review the AgriSafe Nurse Scholar Program – Group Seat Pricing Structure. If you have any questions or would like additional information about Nurse Scholar, contact Ansley Fey (afey@agrisafe.org).

Office Hours: AgriSafe’s office is open Monday through Friday, from 8:00 AM to 4:30 PM CT. Any inquiries submitted outside of these hours will be addressed on the next business day.


Group Seat Purchase Form – Nurse Scholar

Name(Required)
Email(Required)
Address(Required)

Payment Details

Nurse Scholar Program (price per learner)(Required)
I have read the AgriSafe Nurse Scholar Program – Group Seat Pricing document and understand the requirements for the price per learner option selected.(Required)
Document available here: https://www.agrisafe.org/wp-content/uploads/2025/02/AgriSafe-Nurse-Scholar-Program-Group-Seat-Pricing.pdf
Please enter a number greater than or equal to 2.
How would you like to pay?(Required)