Boston Area CSA Signup Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Names and Emails of Additional MembersAre you a new or returning member?* New Member Returning Member If you are a new member, who referred you?Please Choose a Pickup Location:Pickup Options*Brookline: Curds & Co. (Tuesday)Medford: The Corner Studio (Tuesday)East Cambridge: Clover HUB (Thursday)Central Square: Clover HFI (Thursday)Downtown: Clover DTX (Thursday)Longwood: Clover LMA (Thursday)Kendall Square: Clover KND (Thursday)Harvard Square: Clover HSQ (Thursday)Financial: Clover FIN (Thursday)Please Choose from Our Share Options:2019 Small CSA Share (+Fruit) Price: $475.00 Quantity: Feeds 1–3 people, June–October (20 weeks)2019 Regular CSA Share (+Fruit) Price: $695.00 Quantity: Feeds 3–5 people, June–October (20 weeks)Please Select Payment Options:Payment Options:*Pay in full nowSend a $100 deposit now, an additional $100 payment in January, and the balance by May 15thSend a $200 deposit now and pay the balance by May 15thFull Payment Total: Price: $0.00 Total Due Today: Price: $0.00 Admin Adjustment Price: $0.00 Payment Method:*Mail a check (preferred)Pay online using PayPal or Credit CardYou will be redirected to PayPal for payment. If you do not have a PayPal account, look for the "Pay with Debit or Credit Card" button.Membership Agreement (please check)*I understand that while Crimson & Clover Farm is planning for a bountiful 20-week harvest there is no guarantee of the exact amount or type of fruits and vegetables that I will receive through the season. I understand that my deposit is non-refundable. I Agree CommentsThis field is for validation purposes and should be left unchanged.
