CSA
Membership Application

STOP!  You do not need to fill out this application.  We've reached 200 members!  The application process is now over for 2008.  IF any spots open up, we'll email those on the waitlist.  So PLEASE DO NOT FILL OUT THIS APPLICATION. Thank you!! If you have not yet been placed on the waiting list, please email Gina at victoryfarms@comcast.net to be added. 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 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 from the 17th Street Farmer's Market or the Byrd House Community Market in Oregon Hill (additional location TBD)?	yes no
If not, can you make arrangements with a friend or family member to pick it up for you or are you willing to have it donated to a food shelter?	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?