Name(s)
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Street Address
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City
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State
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Zip Code
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Phone
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Email Address (Primary)
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(Optional) Second Email Address, if additional individual would like to receive the newsletter
(Optional) Third Email Address, if additional individual would like to receive the newsletter
Share type for twenty-week season (Check One)
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Pick-Up Location (Check One)
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Partner Shares
The FairShare CSA Coalition provides financial assistance though the Partner Shares program. Please contact FairShare for more information on the application process.
If you are paying by check and would like to donate to the Partner Shares program, check the box below and specify the amount. You can add this to the total amount submitted for your share, and we will send the full donation amount to FairShare. To submit an online donation, click the Donate button here: plowsharesandprairie.com/fairshare-endorsement/.
Partner Shares Donation ($)
Health Care Rebates
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Our CSA shares are eligible for rebates from some health care providers (either via direct reimbursement for the share purchase or through point programs). See our website (plowsharesandprairie.com/health-insurance-rebate/) for more information on available options.
Do you plan to apply for a direct reimbursement for the purchase of this CSA share?
How did you hear about our CSA?
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I am a returning member
Referred by a friend or co-worker
FairShare website
FairShare Open House
Our website
Facebook
Instagram
Market customer
A commercial on TV directing me to thatscsa.org
An online video ad directing me to thatscsa.org
A post on Facebook or Instagram directing me to thatscsa.org
A radio spot directing me to thatscsa.org
A Google search for nearby farms
Other
Member Agreement
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As a member of Plowshares & Prairie Farm, LLC, I understand I will be receiving a box of produce for 20 weeks between the week of June 1st, 2020 and the week of October 26th, 2020. It is my responsibility to pick up my box from the drop-off location each week between the designated hours. If I cannot pick it up, I will find someone else to pick it up and give them instructions for where and when to get it, or my box will be donated. I understand that my farmers will be working to provide me with fresh, healthy produce, but that mother nature will inevitably introduce some variability into the season.
[As your farmers, we commit to working every day to provide you with fresh, local produce. We’re excited to share our passion for healthy food and healthy land with you, and we welcome you to visit our farm and be a part of growing your food. Your farmers, Chelsea & Scott]
Other Notes
Let us know if you have any other comments, questions, or requests. For example, some people splitting shares request multiple receipts.
