Maysie's Farm Conservation Center - Join the CSA for the Current Season

2008 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	________________________________________________
PHONE	________________________________________________
ADDRESS	________________________________________________
	________________________________________________
EMAIL	________________________________________________
Note: Our primary means of communication is email. We do not disclose our membership information to outsiders.

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 at Maysie's Farm: $690

________FAMILY SHARE, picked up at Jenkin's Arboretum, Devon, PA: $890
(Only a limited number of shares will be available for pickup at the Arboretum. Pickups will be on Tuesdays only. Call us for availability.)

RETURNING MEMBERS registering by February 15, 2008, please deduct $50

PAYMENT OPTIONS

_____ Full Payment Upon Enrollment

_____ Two Payments (Half Plus $10 Upon Enrollment, Half Plus $10 Due July 15)

_____ Other

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

PREFERRED PICK-UP DAY at Maysie's Farm____Monday 1:00-7:00 ____Friday 12:00-6:00

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
________________________________________________

NAME
________________________________________________

PHONE
________________________________________________

ADDRESS
________________________________________________

________________________________________________

EMAIL
________________________________________________

AS A 501(c)3 CHARITABLE ORGANIZATION, WE NEED YOUR SUPPORT!
Your tax deductible contribution will enable us to conduct our educational programs, which include Sustainable Agriculture Internships, School and Youth Programs, Teacher Training Workshops, Outreach Programs and a Farm and School Partnership. We greatly appreciate any help you might offer toward our mission of improving public understanding of the importance of conservation and ecological thinking and toward our efforts to promote a local, sustainable food system. 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.