2013 South Bronx CSA Registration Online Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for joining us! Please fill out ALL the areas.

First Name *

Phone *

Last Name *

Email *

Address *

Combined Household Income *

NOTE THE SHARE FEE PLEASE Please choose a share price based on your household income. We use the honor system – no question asked! Please choose the highest amount you can afford, to help our CSA remain accessible to all. Combined Household/Sharing Income* Please select the highest level you can afford, this allows us to offer membership to others and have a successful project!.

EBT/SNAP * Share will be $240

UNDER $20,000 * Share will be $280

$20,001 - $35,000 * Share will be $320

$35,001 - $50,000 * Share will be $360

$50,000 and above * Share will be $440

Required

Payment Options *

Checks or Money Orders to: Friends of Brook Park / South Bronx CSA P.O. Box 801 Bronx, NY 10454

Pay On Line Now . (Click the link in the confirmation email when you complete this form.)

Pay using SNAP/EBT Benefits. SNAP guidelines require the full share be paid in weekly installments throughout the CSA season. IF YOU SIGN UP YOU MUST PAY EVERY WEEK.

Pay HALF On Line Now. Balance Due by May 1st.(Click the link in the confirmation email when you complete this form.)

I want to make other arrangements and will contact you

Other:

Required

Please Fill in your name here to agree. *

As a member, I agree to: 1. Pick up my share each Wednesday at Brook Park or my pick up location between 3 pm and 7 pm (exact times to be determined). If I am unable to come, I will send someone to pick up my share, and/or contact the Distribution Coordinator. 2. Make regular timely payments in accordance with my payment plan. 3. Be sure to do my four hours of required volunteer work. As a member, I also understand that I am sharing the risk of a small farm. Although the farmer agrees to try his hardest to provide the CSA with an adequate quantity and variety of vegetables during the season, weather, bugs and other factors beyond his control may affect my share. If I choose to discontinue my membership, I must notify the CSA Coordinator. My share is non-refundable. Call 646-648 4362 or email information@friendsofbrookpark.org if you prefer to drop off your payment or if you have questions about the program.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms