WINTER GREEN FARM COAST 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 locations
FLORENCE
Friday Delivery Site
Nature's Corner Cafe & Market, 185 Highway 101 - Florence
REEDSPORT
Friday Delivery Site
1890 Greenwood Ave. - Reedsport
COOS BAY/NORTH BEND
Friday Delivery Site
1198 Winsor Ave. - North Bend
HARVEST SHARES (includes delivery)
Standard Season: (19 weeks, mid-Jun – mid-Oct)
Late Season: (Additional 5 weeks, mid-Oct – Thanksgiving)
FLORENCE
Standard Season - Florence $475 $
Late Season - Florence $185 $
REEDSPORT
Standard Season - Reedsport $485 $
Late Season - Reedsport $190 $
COOS BAY/NORTH BEND
Standard Season - Coos Bay/North Bend $495 $
Late Season - Coos Bay/North Bend $195 $
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.

or select one of the following:
Payment in full on signing
Pay half now, half by August 15
5 monthly payments (June-October)
Monthly payments should be made by the 1st of each month.
Payment may be made by check or debit/credit card. Mail checks to address below
or call/write farm with credit card payment information.

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 button below. If you need to delete the information in the form and start over, click the Reset button.
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