Prince George – Norwich Meadows Farm CSA

Membership Registration/Agreement Form Winter 2012-2013

Name:

Address: City: State: Zip: ______

Daytime Phone: Alt. Phone: ______

Email Address:

Are you a past member? ______How did you learn about this CSA?

Membership Commitment

I, , commit to membership in the Prince George – Norwich Meadows Farm CSA for the 2012-2013 Winter Season. As a member, I commit myself to supporting the farm with timely payments. In addition, I commit myself to pick up my seven (7) deliveries at The Prince George at 14 East 28th Street. I do not expect my share to be saved. I also understand that I am expected to give a minimum of two (2) hours of volunteer time to the CSA over the course of the season (December-May), and that my failure to complete these volunteer hours will impact my future participation in the Norwich Meadows Farm Prince George CSA.

I understand that there is no guarantee on the exact amount or type of produce I will receive in my share. By participating in the CSA, I am supporting the local farmer as well as more equitable food distribution and I am helping to create a more environmentally just, economically fair, and healthy society.

Share Options (Please Check One)

***Note: All share costs include a one-time $10 distribution fee for the season.

______A. “Standard” Meat Share. This $290 share option will include meat products such as chicken in addition to the share items that include vegetables, dairy products and local NY state products. The “Standard” Meat Share comes at a $40 weekly value.

______B. “Standard” Lacto-Ovo Vegetarian Share. This $290 share option will not include meat, but will include dairy products in addition to the share items of vegetables and local NY state products. The “Standard” Lacto-Ovo Vegetarian Share comes at a $40 weekly value.

______C. “Large” Meat Share. This $360 share option will include meat products such as chicken in addition to the share items that include vegetables, dairy products and local NY state products. The “Large” Meat Share comes at a $50 weekly value.

______D. “Large” Lacto-Ovo Vegetarian Share. The $360 share option will not include meat, but will include dairy products in addition to the share items of vegetables and local NY state products. The “Large” Lacto-Ovo Vegetarian Share comes at a $50 weekly value.

Payment Plan Options (Please Check One)

Full payment of $360 or $290 (check or money order made out to Common Ground Community II)

______Food Stamps beginning with a deposit of $30 enclosed (check or money order made out to Common Ground Community II)

Payment Plan:

For the$360 Share, I will make 2 equal payments of $180

For the$290 Share, I will make 2 equal payments of $145

The first payment should be submitted by Thursday, October 18

The second payment should be paid by Tuesday, December 11th, at the first distribution, if not before.

Checks and money orders must be made payable to Common Ground Community II. No cash please. Registration and payment is due by Thursday, October 18th, 2012.

***Please note that there will be a $10 late fee to all late payments.

***Note: The tentative days for distribution are the following Tuesdays:

December 11th, January 22nd, February 12th, March 5th, March 26th, April 16th, and May 7th

Donation:

The Prince George is a low-income and supportive housing unit, and one of the core goals of our CSA is to increase the availability of healthy affordable produce to low-income populations. With this in mind, one of the services we offer is a Farmers market for the tenants of the Prince George. We buy three shares from the Farm and sell the produce to tenants of the Prince George at discounted prices for tenants who may be unable to buy a CSA share. We are hoping to buy a minimum of three shares for the 2013 Summer CSA Season, and are seeking donations from our members to do so. Please consider donating any amount to the Prince George Farmers Market for the Summer 2013 Season. Checks can be made payable to Common Ground Community II and should be a separate check from the check for a share.

_____Yes, I would like to make a donation of $______. Please make a separate check or money order to Common Ground Community II.

Member Signature: Date:

CSA Coordinator Signature: Date:

Please return this form completed & with payment to:

Rachel Boeglin, The Prince George-CSA, 14 East 28 Street, NY, NY 10016.

Please direct questions to or 212.471.0858 or visit www.commonground.org/csa.