Fertile Ground Food Cooperative Member Application
Complete this form before paying your household membership via this Fertile Ground website.
First Name *
Your answer
Last Name *
Your answer
Home street address *
Your answer
Apartment, unit, suite
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Mailing Address (if different from above)
Your answer
Email address
Your answer
Phone (home)
Your answer
Phone (cell)
Your answer
First & last names of other household members, residing at your address, who have your permission to use your membership number. Remember that adults can also join independently.
Your answer
How did you learn about Fertile Ground? (Check all that apply.) *
Required
If you learned about Fertile Ground from a family/friend, list the name.
Your answer
Which workgroup (committee) would you like to join? *
Which of your skills will you share with the cooperative? *
Required
Are you able to volunteer two (2) or more hours per week to Fertile Ground work? *
What is your grocery spending per month? *
Your answer
After paying my membership, I want to become a sustainer & donate regularly to Fertile Ground. I understand that sustainers still have only one share and one vote. *
I am interested in future opportunities to invest additional funds to support the construction and development of the Fertile Ground grocery store and gathering space. *
Preferred stock owners 'loan' an amount to Fertile Ground for a specified time and return. More information available for these prospective preferred stock owners.
After becoming a member, I give my consent and waive any and all claims regarding the use of my image in FGFC publications, print and digital, from my participation in FGFC events, e.g., meetings, festivals, etc. *
I understand that I must now go to PayPal to complete my membership by paying $100 as a founding member. *
I understand that I must now go to PayPal to complete my membership by paying $25 now & $25 monthly until $100 is paid within eleven months or less. *
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