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:  
Zip:  
Home Phone:  
Alternate Phone:  
Email:  
Email Confirmation:  
Have you been a member of a CSA before?  
Do you currently try to purchase organic produce when available?  
Are you willing and able to pick up your produce weekly?  
How many meals per week do you eat at home?  
How did you hear about us?  
 
 


 
       

victoryfarms@comcast.net | 804-559-8833 / 7349 Woodville Lane, Hanover, VA 23069 | ©2007 Victory Farms Inc.