Author: melba
Last saved by: MudSongs

VEGGIE COOP - 2012 SEASON MEMBERSHIP APPLICATION

Name:________________________     E-Mail: _______________   Date: __________

Address: ______________________   Phone – Work: ___________     

                                  Phone - Home: ___________

                                  Phone - Cell: ___________

Smaller Bag (Mondays): _______    Larger Bag (Wednesdays): _______

Either Bag is acceptable: _______

Payment Rates (smaller bag):  Returning Members: $420.00        

Payment Rates (larger bag):   Returning Members: $588.00        

Checks are preferred form of payment. If this is not feasible, please contact: Mike Rabinowitz to make a plan. Make cheques payable to: Organic Farm and mail to: Organic Farm, 42 Churchill Rd. Portugal Cove-St. Philips, NL. A1M 2P6 or drop off at farm or house.  

Please check one: 

Total subscription enclosed in 1 check dated June 20th ____

Total divided in 2 checks dated June 20th and August 15th ____ 

Total divided in 4 checks dated June 20, July 15, Aug 15, Sept 15 ____

Arrangements for pick-up:

_____ Science Building Parking Lot	    _____ Organic Farm Chill Room

Sharing with: __________________  E-Mail: ____________________                                                              

					    Phone: _____________

Sharing with: __________________  E-Mail: ____________________                                                              

					    Phone: _____________

If you are planning holidays, please remember to let us know by e-mail no later than one week in advance and earlier if possible.