[A Printable Version HERE]
2013 CSA MEMBERSHIP APPLICATION
Name______________________________
Address_____________________________
___________________________________
Phone ______________________________
E-mail_______________________________
Please choose a share option:
1. Regular Share:
- Weekly Share: $360 _______
- Biweekly Share: $180 _______
2. Extended Season Share:
- Weekly Share: $504 _______
- Biweekly Share: $252 _______
3. Fall Share: $252_______
4. Work Exchange or Barter: ______
Circle a Pick Up Option:
- Monday On Farm Pickup
- Wednesday Blue Ridge Summit Pickup
- Wednesday Waynesboro Pickup**
**If you live in Waynesboro and would like home delivery on Wednesdays, please add $60 for a Regular Share and $30 for the Biweekly, Summer or Fall share.
Added Delivery Charge ________
Grand Total______
CSA Agreement: I agree to pay the above amount by March 2013. I understand that The Amazing Heart depends on my financial support and/or labor for its survival. In return, the CSA will provide me with the best produce possible. I understand that production may vary with weather conditions. I also understand that I will not get my money back if I decide to discontinue my share once the season has started.
Signed__________________________
Please print this form and send it, with payment, to: Amazing Heart Farm 181 Orrtanna Road Orrtanna, PA 17353
