CSA
Membership Application

STOP! You do not need to fill out this application. We are not yet accepting general applications for 2010. But we're happy to add you to our new waiting list! To be placed on the waiting list, DO NOT FILL OUT THIS APPLICATION, please email Gina at victoryfarms@comcast.net. Thank you!

* all fields are required

Name:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Columbia Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York Non US State North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Home Phone:
Alternate Phone:
Email:
Email Confirmation:

Have you been a member of a CSA before?	Yes, Victory Farms in 2008 Yes, Victory Farms in 2007 Yes, another CSA no
Do you currently try to purchase organic produce when available?	yes no
Are you willing and able to pick up your produce weekly?	yes no
How many meals per week do you eat at home?	1 2 3 4 5 6 7 8 9 10 11 12 13 14 all meals
How did you hear about us?