CSA Sign-Up Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe 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?(New members and those who refer them get $10 credit to the farm store)Please choose from our Share Options:*2019 Small CSA Share | $515 (feeds 1-3 people), June-October (20 weeks)2019 Regular CSA Share | $695 (feeds 3-5 people), June-October (20 weeks)2019 Small Share Add-On | $90 (feeds 1-3 people), Late October-Thanksgiving (4 weeks)2019 Regular Share Add-On | $130 (feeds 3-5 people), Late October-Thanksgiving (4 weeks)Please choose a Payment Option:*Pay in full nowSend a $100 deposit now, an additional $100 payment in January, and the balance by April 1stSend a $200 deposit now and pay balance by April 1stPlease choose a 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.Small Share: Full Payment Price: $515.00 Regular Share: Full Payment Price: $695.00 Small Share Add-On Price: $90.00 Regular Share Add-On Price: $130.00 $100 Deposit Price: $100.00 $200 Deposit Price: $200.00 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.
