PLEASE PRINT THIS FORM AND MAIL IT WITH YOUR CHECK. Make the check payable to Blue Ridge Center and write "NEW" on the memo line. Then send the check and your completed form to:

Blue Ridge Center CSA
11661 Harpers Ferry Road
Purcellville, VA 20132

Yes, I would like to join the Mountain View Farm Program at the Blue Ridge Center. I understand that I'm entitled to my share of the farm's bounty. Our CSA farm workers are not liable for extreme weather conditions or other "acts of God."

__________________________________   _______________
   Signature                                                      Date

Primary Shareholder: _____________________________________

Other Shareholder: _____________________________________
(if applicable)

Address: __________________________________________________

City: ___________________________ State: ____ Zip: ___________

Email: _____________________________________________________

Phone (Evening): ___________________________

Phone (Day): _______________________________

SHARE OPTIONS

____  $375 CSA Share for 22 weeks of fresh herbs and vegetables

____  $100 Flower Share for 12 weeks o garden fresh flowers

____  $60 Full Egg Share for 1 dozen eggs for 20 weeks

____  $30 Half Egg Share for 1 dozen eggs every other week for 20 weeks

$_____ TOTAL ENCLOSED

SHARE PICK-UP
I plan to pick up my farm share at the Blue Ridge Center on (CIRCLE ONE)

       Saturday 9am to 2pm from June 4th through October 29th

       Tuesday 2pm to 7pm from June 7th through November 1st

Refund Policy: Only if we are not able to honor your membership OR you choose to terminate your membership prior to the start of the season, will you be refunded.

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