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La Cosecha subsidized small share form 2018
Name *
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Mailing address with zip code *
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Cell or home phone *
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Email *
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How did you hear about La Cosecha CSA? *
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Have you been a member of La Cosecha CSA before? *
If so, which year(s)? *
Does your household meet income eligibility for SNAP? *
Are you diabetic or pre-diabetic? *
How many children are in your household? *
Your answer
How old are they? (Please answer "I do not have children" if you do not) *
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How many people in total reside in your home? *
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Membership Terms (please read and sign)
I agree to pick up my CSA share each week for the rest of the season, the duration of which is determined by my date of sign up. The entire 2018 season dates from June 13th to October 25th. I understand that in return for the produce I am being provided, I am investing in the farmers of Agri-cultura Network. I will make every effort to make my payments on time, and to pay for any shares that I am unable to pick up, unless I have given advance notice the week before that I cannot make it. I may have someone pick my share up for me if I cannot make it. I understand that any shares not picked up will be donated, and there will be no refunds issued. If I do not pick my share up for two consecutive weeks without communicating I will be dropped from the program. If I am four weeks behind on my payments I will be dropped from the program. I understand the type and amount of produce in my bag will vary from week to week based on seasonality and availability. I may change the size of my share a week in advance. Payments can be made using cash, check, credit card, or SNAP. Checks can be made out to Agri-cultura Network.
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Date *
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I will pay *
My pick up location, day and time is *
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