Blue Gate Farm Bounty Box (CSA)

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2026 Membership Form

(If you need more info click here: Blue Gate Farm Bounty Box)

Email *

Last Name *

First Name *

Street Address *

City *

Zip *

Phone #1 *

Phone #2

Email (alternate #1)

Email (alternate #2)

Pick-Up Location *

Des Moines, HoQ Restaurant

Knoxville, Grand Theater

on farm

# of Base Produce Memberships ($650) *

Are you splitting this share with another household? *

Yes

If you are splitting your box, please include their name, phone # and email below

If you are a new member and someone recommended us to you, please share their name so we can thank them!

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