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ISA Membership Application
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1
. Fill out your contact information.
Fill out your contact information.
Name:
Company:
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Country:
Email Address:
Phone Number:
2
. Referred by:
Referred by:
3
. I am interested in volunteering:
I am interested in volunteering:
Yes
No
4
. I am interested in shaping state and federal policies that impact small farms and local foods. Tell me more about the Grassroots Policy Advisory Committee.
I am interested in shaping state and federal policies that impact small farms and local foods. Tell me more about the Grassroots Policy Advisory Committee.
Yes
No
5
. I am a:
I am a:
farmer
gardener
interested citizen
chef
educator
local food entrepreneur
food service professional
non-profit representative
agriculture professional
school representative
student
Other (please specify)
6
. Membership Level
Membership Level
$15 - Student/Low-income
$25 - Individual
$50 - Family/Joint
$50 - Farm
$75 - Supporter (Receive a cookbook or t-shirt)
$100 - Organization/Business
$300 - Steward (Receive 2 Tickets to ISA's Annual Dinner in September)
$300 - Sponsoring for Organization/Business
$500 - Sustaining for Organization/Business
$1,000 - Lifetime Member (Receive 2 Tickets to ISA's Annual Dinner and a food-bearing tree planted in your honor in a community garden)
Want to change your gift option? Tell us here:
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