Returning Member Information and Agreement 2020 Survey

1.Primary household member (must be completely filled out)(Required.)

Name

Address (street, city, zip)

Landline Phone (if no phone, enter n/a)

Cell Phone

2.Secondary household member (optional, but VERY helpful to us)

Name

Address

Landline (if no home phone, enter n/a)

Cell Phone

3.At times, situations may arise that we need to make you aware of. We will always send an email to everyone, but we know everyone isn't "tied" to their email. If we need to contact you regarding an urgent matter, which do you prefer?

Email is fine

Please text me if urgent

Please call me if urgent

4.Please indicate your Preferred Share Type:

Traditional CSA

Pre-paid Debit Card

Undecided NOTE: You will be required to commit to a Share Type by May 19, 2019

5.Please check EACH box to indicate you have read and agree with all of the guidelines and policies.(Required.)

I understand Leaning Birch Farm’s Risk and Reward Policy, and I am agreeing to share in the risk and reward of farming, as described in the Membership Handbook.

I understand Leaning Birch Farm's Refund Policy, and in agreement with it, as described in the Member Handbook.

I understand the guidelines for visiting Leaning Birch Farm. I agree to follow all posted signs and rules when at the farm, and I understand that pets should stay at home.

I understand that I must pick up my share within the pick-up time frame that corresponds to the site I select and that if I do not, and I do not contact the farm, I may forfeit my share for that week.

I understand that if I would like to have someone else pick up my share for me, I must contact the farm to inform them of this ahead of time.

If I cannot pick up my share during the pick-up time frame, Leaning Birch Farm may be able to hold my share for a day or two. In this case, I understand I must contact the farm ahead of time to arrange for a special pickup.

6.I agree to pay Leaning Birch Farm my original membership fee (as specified in the email I received from the farm) for 18 weeks of produce which I will receive according to the guidelines set up for my Preferred Share Type as described in the Membership Guidelines on the farm's website.

I understand that entering my name in the textbox below represents my signature. When I submit this form, I am indicating that I am in agreement with all of the guidelines and policies indicated above and described in the Member Guidelines on the farm's website.(Required.)

Current Progress,

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