2011 CSA MEMBERSHIP FORM

MAYSIE’S FARM CONSERVATION CENTER
COMMUNITY SUPPORTED AGRICULTURE
15 St. Andrew’s Lane, Glenmoore, PA 19343
Email: Sam@maysiesfarm.org | Phone: (610) 458-8129

Think Globally, Eat Locally


Please print clearly:

NAME
 
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PHONE
 
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ADDRESS
 
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EMAIL
 
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Note: Our primary means of communication is email. We do not disclose our membership information.

MEMBERSHIP OPTIONS
If sharing a share, please provide complete contact information for the other household(s) on the bottom of this form.

________FAMILY SHARE, picked up weekly at Maysie's Farm: $750
Preferred pick-up day:____Monday 1:00-7:00 ____Friday 12:00-6:00

________FAMILY SHARE, picked up at Jenkin's Arboretum, Devon, PA: $900
(Only a limited number of shares will be delivered — on Tuesdays — to the Arboretum. Call us for availability.)

________SMALL SHARE, Family Share quantity picked up alternate weeks at the farm: $400
Pick-up starting:____Friday 27 May ____Monday 30 May ____Friday 3 June ____Monday 6 June

________SMALL SHARE, Family Share quantity picked up alternate weeks at Jenkins: $475
(Jenkins shares include pick-your-own crops and delivery of any cooperative marketing products ordered.)

PAYMENT OPTIONS

  _____ Full Payment by January 15, 2011: Please deduct 4%

  _____ $200 Deposit by January 15, balance by March 15, 2011

  _____ $200 deposit, then 1/2 of balance + $10 by April 15 and 1/2 + $10 by July 15, 2011 ___________

  _____ Other

PAYMENT ENCLOSED(Please make checks payable to Maysie’s Farm Conservation Center)

IN EXCHANGE FOR MEMBERSHIP PAYMENT, I accept the commitment from Maysie’s Farm Conservation Center to provide each member with an equitable share of organically grown produce for the season. I understand that farming is not without risks and that forces beyond the Farmer’s control may adversely effect the harvest. In addition, I understand that some portion of the crops grown at Maysie's Farm will be sold as cash crops outside the CSA. I release Maysie’s Farm Conservation Center from any responsibility or liability for injuries which I, or anyone accompanying me, may incur as a result of being on the premises.

 

SIGNATURE: _____________________________________________
 
 
DATE: ___________________________


IF SHARING A SHARE, please provide complete contact information for the other household(s):

NAME
 
________________________________________________
PHONE
 
________________________________________________
ADDRESS
 
________________________________________________

 
________________________________________________
EMAIL
 
________________________________________________
COMMENTS
 
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NAME
 
________________________________________________
PHONE
 
________________________________________________
ADDRESS
 
________________________________________________

 
________________________________________________
EMAIL
 
________________________________________________
COMMENTS
 
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AS A 501(c)3 CHARITABLE ORGANIZATION, WE NEED YOUR SUPPORT!
Your tax deductible contribution will enable us to conduct our educational programs and effectively promote the concept of a local, sustainable food system. Our programs include The Anselma Farmers and Artisans Market, Farm and School Partnerships with the Montgomery School and Conestoga High School, other School and Youth Programs, Sustainable Agriculture Internships, Teacher Training Workshops, and a variety of Outreach Programs. We greatly appreciate any help you might offer toward our general mission of improving public understanding of the importance of conservation and ecological thinking or toward our specific goal of establishing a local, sustainable food system here in Chester County, Pennsylvania. THANKS FOR YOUR SUPPORT!

________ $500 ________ $250 _________ $100 ________ $50 ________ Other


The official registration and financial information of Maysie’s Farm Conservation Center may be obtained from the Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement.