Membership Application

[A Printable Version HERE]

2012 CSA MEMBERSHIP APPLICATION

Name_______________________________

Address_____________________________

_____________________________

Phone ______________________________

E-mail_______________________________

Please choose a share option:

Extended Season:

Weekly Share: $500 _______
Biweekly Share: $250 _______

Summer Share: $275 _______

Fall Share: $240_______

Please circle a pick up option:

Monday On Farm Pick-up
Tuesday Gettysburg Pick Up at St. James
Wednesday Blue Ridge Summit Pick Up
Wednesday Waynesboro Pick Up

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 2012. 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__________________________