Blue Ridge Center: Agroecology & Agricultural Stewardship

Blue Ridge Center for Environmental Stewardship

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Agroecology & Agricultural Stewardship

SIGN UP FOR COMMUNITY SUPPORTED AGRICULTURE

Please print out and fill in the form below if you wish to participate in the Blue Ridge Center's Community Supported Agriculture program. OR, you can charge it to your credit card through our PayPal account. To use this option, go to www.PayPal.com and send a payment to [email protected]. Paypal is safe, secure and easy to use and takes about 5 minutes to join online at PayPal.com.

If paying by check, enclose a check for $300 for a two person share or $460 for a family share. Include an extra $30 if you plan to pick up your share at one of our drop off locations. There is no additional charge if you pick up your share at the Blue Ridge Center.

Yes, I would like to be a shareholder in the Blue Ridge Center Community Supported Agriculture program. I understand that the farm workers will do their best to provide all that they have promised and I agree to forgive them of mishaps that may trip them up.

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Signature Date

Name of Primary Shareholder:

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Address: ______________________________________________________

City: ______________________________ State: _______Zip: _________________

Email: _______________________________________

Home Phone: __________________________________

Work Phone: __________________________________

FAX: ______________________________________

I am interested in food for a family of:
Two/$300
Four/$460

Food Delivery
I plan to pick up food at the Blue Ridge Center.
I plan to pick up food at the drop off location (extra $30 for season applies).

I would like a flower share as well. I'll get a bouquet of freshly cut flowers each week for only an additional $99.

Total enclosed: _____________

I have broken my payment into two checks and have sent both the current amount due and the balance as a post-dated check. I understand that the post-dated check will not be cashed until the date I have written on the check.

My preferred pick up location is:

_______________________________________________________________________

_______________________________________________________________________

I would be interested in hosting a pickup location at my home or business. If you are in need of a site in my area, please contact me.

Questions, comments or suggestions about Blue Ridge Center Community Supported Agriculture program:
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Please make out your check to Blue Ridge Center and send your completed form to Blue Ridge Center CSA Program, 11661 Harpers Ferry Road, Purcellville VA 20132.

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