WINTER GREEN FARM BEND 2010 MEMBERSHIP FORM
Yes, I would like to share in the healthy harvest!
E-mail Address:
*
Name (primary contact)
*
Address
*
City
*
Zip
*
Home Phone
*
Other Phone
Will you split your share with another family? Please include their information:
Name (primary contact)
Address
City
Zip
Home Phone
Other Phone
Email address
Pickup site day & location
Wednesday
,
Bend Farmer’s Market
,
Mirror Pond Park
HARVEST SHARES (includes delivery)
Standard Season (19 wks, mid-June - mid-Oct)
$
Donation to Financial Assistance Fund
$
Donation to Education Program
$
Returning member discount or credit
—
$
Total Due for Season
*
$
Payment Options
Payment in full online by debit or credit card using the secure shopping cart.
You will be routed to a page to select the shopping cart option when you submit this form to the farm.
Payment in full on signing
Pay half now, half by August 15
5 monthly payments (June-October)
If you are interested in our financial assistance options, please call Linda at the farm.
FOOD For Lane County
I wish to support the Womenspace Transitional Program with a tax deductible donation.
I am enclosing a separate check made out to: FOOD for Lane County for $
COMMENTS
Please send a copy of our print brochure to:
How did you find out about Winter Green Farm?
Box Notes
are seasonal weekly newsletters. They provide farm news and relevant vegetable recipes.
Subscribing to Email Box Notes means you will receive a weekly email instead of a paper version at your pick-up site
Please subscribe me to Email Box Notes
I would like to receive farm communication by email to help conserve paper
To join us for the 2010 season
When you have entered all the information, click the Submit button below. If you need to delete the information in the form and start over,
click the Reset button.
*
Required