Long Island City CSA Membership Agreement by KC5mgBBc


									                                                            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
 Plan                                                                                                -
                                                                                                     - 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? _______________________________________________________________________

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