2015 Membership Application Name:__________________________________________ Date: _____________________ Company/Organization:________________________________________ Mailing Address:_____________________________________________ City:___________________ State:______ Zip:______ Physical Address:____________________________________________ City:____________________State:______ Zip:______ Telephone:_______________________ Email (primary voting member): ____________________________________________ Website:___________________________________________________ Grower and Allied Members, option to list other emails for your organization (up to 3 will receive member emails): Name: _____________________________________ Email: ___________________________________________________ Name: _____________________________________ Email: ___________________________________________________ Name: _____________________________________ Email: ___________________________________________________ Please indicate membership type (select one):     Grower Member – (please check the level of annual gross sales below) Any person, partnership, corporation or other entity with office or facilities located within the state of Colorado engaged in growing vegetables and fruits for commercial purposes Annual Gross Sales Determines Annual Dues Owed (each Grower Member has one vote)  $300 - Annual gross sales over $500K  $200 - Annual gross sales $100K-$499K  $100 - Annual gross sales under $100K Allied Member Any person, partnership, corporation, or other entity with a financial interest in the commercial vegetable and fruit industry in Colorado. Allied members have the right to vote.  $300 Partner Member Any person with a collaborative interest in CFVGA that is an employee of CSU Extension, research, teaching and/or other higher education institution or an employee of any government entity that is involved in exemplary contribution to the commercial vegetable and fruit industry in Colorado who pays the annual membership dues and is approved for membership by the Board of Directors or its designee shall be a Partner Member.  No cost in 2015 (Partner members do not have voting privileges) General Interest Member (GIM) Any person that does not qualify for any of the above membership categories, who is approved by the CFVGA Board of Directors for their inclusion into this category and who pays the annual membership dues. General Interest Members have no direct financial interest in fruit and vegetable production but would like to stay informed about the Association Activities and assist the CFVGA achieve its mission in Growing Resources and Cultivating Success for Colorado fruit and vegetable farmers.  $25 (GIM do not have voting privileges) Total due: $________________ **See Page Two for Pay to and Mail to Info** 1 Payments to Colorado Fruit and Vegetable Growers Association are not deductible as charitable contributions for federal income tax purposes. However, they may be deductible under other provisions of the Internal Revenue Code. Make checks payable and mail to: Pay to: “CFVGA” Mail to: Vickie Root PO Box 2255 Loveland, CO 80539 Internal use only Received: Payment status: Member status: Confirmed as member (date): Notes: Questions? [email protected] 970-667-4949 (office) 720-306-2878 (fax) 2