Elderberry Hill Farm 2015 CSA Agreement and Membership Form Member Information: If splitting a share, please provide contact info for both households Name(s): ___________________________________________________________________________________ Phone: _____________________________________________________________________________________ E-mail(s): __________________________________________________________________________________ Members will receive an e-mail confirmation and receipt. More information will be provided by email before deliveries begin. If you plan to request a rebate, please keep a copy of this form and your receipt to send to your insurance provider. CSA Share Selection: Full Summer Share- Fresh, seasonal vegetables every week for 20 weeks. Small Summer Share- A smaller box of vegetables every week for 20 weeks. Winter Share- 3 large boxes: Oct. 22, Nov. 5, and Nov. 19 Total $620 ($31/week) $380 ($19/week) $165 $______ ***Early bird special (circle ONE): Sign up by February 15 and choose either a $15 discount or a $30 gift card to use at our Farmers' Market stand. Reduce your payment by $15 if you choose the discount. Market credit is valid May 2015 - December 2015. Payment options: I. Pay 'total amount due' with one check dated today, II. Include two checks, each for half of the total, one dated today, the other postdated June 1st, or III. Email me to set up a personal payment plan. Fairshare Partner Shares offers financial assistance: http://www.csacoalition.org/about-csa/partner-shares/ Pick-up Site Selection: Choose One >> All CSA deliveries are on Thursday. Near West Madison: 1813 Adams St Near East Madison: 926 Spaight St VA Medical Center: Parking Garage, 3rd Level Dane County Dept. of Human Services (**employees only**): 1202 Northport Dr. Assistance Fund Donation: Please help provide CSA shares to lower-income households through the Partner Shares Program. To donate, include a SEPARATE check payable to the Fairshare CSA Coalition. See http://www.csacoalition.org/about-csa/partner-shares/ for more information Member Agreement: I would like to become a member of Elderberry Hill Farm's CSA program. The farmer promises to make all efforts to provide you with a season of bountiful, tasty, and high quality produce. Every season will be different depending on the weather and growing conditions. By becoming a member of Elderberry Hill Farm's CSA I agree to share in the abundance and the risks along with the farmer and other CSA members. I understand that membership is a season long commitment and I agree to pick up my CSA share on my designated place and time. _________________________________________________ Signature and Date Thank you! Please fill out and mail to Eric Elderbrock, 926 Spaight St #2, Madison, WI 53703 www.elderberryhillfarm.com - [email protected] - 608-772-4461