Georgia Premises Registration - Georgia Premises Registration

Georgia Premises Registration

Divisions
Animal Industry Division
Animal Health
Avian Influenza
Poultry Premises Identification Form

Avian Influenza is a serious threat to the poultry in Georgia and it is vital that everyone does their part to prevent the introduction and/or spread of the virus. Please assist us in this effort by identifying your premise and providing your contact information in order to receive important tips and updates

* Indicates requried field

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General Information

Owner First Name*

Owner Last Name*

Mailing Address*

City*

State*

Zip Code*

County*

Primary Phone Number*

Secondary Phone Number

Email Address*

Premise Manager (If applicable)

Primary Phone number

Premise Email Address

Business Type

Premises Information

Business/Premises Name*

Physical Address*

City*

State*

Zip Code*

County*

Species on Premises

(check all that apply and include quantity in corresponding column)

Chickens		Geese		Horses
Quail		Pheasants		Goats
Turkeys		Cattle		Sheep
Ducks		Swine		Other

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