Maryland Organic Food and Farming Association Winter Meeting Registration Form
Last Name of Member/Attendee 1
Your answer
First Name of Member/Attendee 1
Your answer
Last Name of Member/Attendee 2
Your answer
First Name of Member/Attendee 2
Your answer
Farm Name
Your answer
Address1
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Address 2
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City
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State
Choose
MD
DE
VA
DC
PA
Zip Code
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Phone
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Alternate Phone
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Cell Phone
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Email 1
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Email 2
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Web Site
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Would you prefer an e-newsletter or print?
E-news
Print
Both
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Are you interested in Volunteering?
Yes
No
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Would you like to be listed as a member on the MOFFA web site?
Yes
No
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Payment:
Annual MOFFA Dues (per farm or family)
One year Membership $25
Two Year membership $45
Student Membership $12
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Payment:
Meeting Fee
1
2
3
4
Quantity
Member Meeting Fee (per person) $5
Non-Member Meeting Fee (per person) $20
1
2
3
4
Quantity
Member Meeting Fee (per person) $5
Non-Member Meeting Fee (per person) $20
Clear selection
Total
Please enter the total amount due. After Completing and submitting the form, please return to
http://marylandorganic.org/join/
to make your secure payment to MOFFA
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