LEAP Winter Farm Share Registration
Please complete the registration form in its entirety. The name and contact information is for the primary Farm Shareholder. If you are splitting a share with a friend or family member and want more than one person to receive the weekly email reminder, you are welcome to provide more than one email address.
If you have any questions, please email
First and Last Name
Farm Shareholder Phone (main)
List email address(es) to which you will receive confirmation and weekly newsletter (if multiple, separate with a comma)
Pick-up Site (All sites are TUESDAY pick ups!)
West End Farmers Market, 1210 Patterson Ave (Tuesday 3-6)
Carilion Roanoke Memorial Hospital, Riverwalk Parking Garage (Tuesday 4:00-5:30)
Vacation day #1 (default will be last share on 12/18)
Farm Share Selection
Winter Share (Single, $285)
Winter Share (Double, $560)
Please make my Winter Share:
Payment (must be paid in full by October 24th)
I will mail a check to LEAP (payable to "LEAP", PO Box 3249 Roanoke VA 24015)
I will pay online with credit/debit (charged additional 3% to cover bank fees)
I will come by the West End Farmers Market or Mobile Market (credit/debit charged 3% fee, no charge for checks)
I will drop off my cash/check payment at LEAP's office (in the CoLab, 1327 Grandin Rd, Roanoke)
I will pay half price with my SNAP-EBT card or proof of Medicaid. If so, please email
for deposit and payment instructions.
I will bring a check made out to LEAP to my Carilion Farm Share pick-up
Are you currently a Farm Share member?
If you are not a current Farm Share member, please list the member that referred you (if applicable).
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This form was created inside of Local Environmental Agriculture Project (LEAP).
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