Long Island City CSA Membership Agreement
Phone: 212-825-0028 ext.201 Website: http://liccsa.wordpress.com
A. Your Contact Information
Name(s) (Please list all the names of the people who will be sharing this share.)
Preferred Method of Contact: Phone / Email
B. The Share C. Payment Options
Full Share: Enough vegetables for 3-4 people every week for 22 weeks-- Full Payment Enclosed
depending on how many vegetables you eat. Amount Enclosed
Half Share: Enough vegetables for 1-2 people every week for 22 weeks--
depending on how many vegetables you eat. Payment Plan
SNAP - $150 Whole Share in SNAP payment only Enclosed is a check for at least 10% of the share cost.
I will pay the full balance by May 24.
Benefit - $75 Half Share in SNAP payment only
Payment - NO deposit required; payment by SNAP is weekly Amount Enclosed
- Food Stamps/SNAP
Household $350 Whole Share I will pay the SNAP portion every week during the
Income - $175 Half Share season.
Below - 10% minimum deposit required;
$25,000 - full payment by May 24 - (SNAP: Full: $6.82/week Half: $3.41/week)
Household $440 Whole Share
Income - $220 Half Share
$25,000 - - 10% minimum deposit required; D. Membership Agreement
$35,000 - full payment by May 24 I commit to membership in the Long Island City CSA for
Household $525 Whole Share the 2010 season. I will pick up my share on
Income - $265 Half Share Wednesdays, between 4pm and 7pm at Jacob A. Riis
$35,000 - - 10% minimum deposit required; Neighborhood Settlement located at 10-25 41st Ave,
$50,000 - full payment by May 24 Long Island City, from June 2 through October 27.
Household $555 Whole Share As a member, I commit to supporting the farm through timely
Income - $280 Half Share payments, and I commit to supporting the CSA by completing 4
Above - 10% minimum deposit required; hours of volunteer time over the 2010 season, either through 2 two
$50,000 - full payment by May 24 hour shifts at the distribution site or in another way. I understand
that if I don’t pick up my share, my food will be donated to a local
Other emergency food provider.
Donation $ CSA members join with their farmer in both the risks of farming
Please consider subsidizing a share for those who cannot afford a full
vegetable share on their own (crop failure, poor weather, etc.) and its benefits (a bountiful harvest
season). I understand that my share will vary from week to week,
generally consisting of 6-10 different seasonal vegetables, and that
there is no guarantee on the exact amount or contents of my share.
Total Amount Enclosed: (Payment + Donation)
The shares will vary in weight, size, and vegetables depending on
the time of the season.
By participating in this CSA, I am bringing healthy, locally grown
food to the neighborhood, supporting alternative agriculture,
building community, and making the world a better place…Sign me
Core Group Interest up!
I’d like to help the CSA Core Group run the Long Island City CSA. Date: ___________________________________
Please contact me about how I can get involved!
Make check or money order payable to “NYCCAH” and mail it with this form by May 24 to:
New York City Coalition Against Hunger
50 Broad Street, Suite 1520
New York, NY 10004
How did you find out about us? _______________________________________________________________________