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2015 Bronx CSA Membership Agreement
Phone: 212-825-0028 Website: bronxcsa.wordpress.com Email: [email protected]
Our CSA is a partnership between the Bronx Community and the New York City Coalition Against Hunger
A. Your Contact Information
Name(s)
Phone
Address
Email(s)
Preferred method of contact: Phone/
Email
B . V e get ab l e Sh ar e
F. M em b er sh ip A gr eem en t
Full Share: Enough vegetables for 3-4 people every week for 22 weeks
Half Share: Enough vegetables for 1-2 people every other week for 11 weeks
I commit to membership in the Bronx CSA for the 2015 season. I
will pick up my share on Tuesdays, between 5:00 pm and 7:30 pm
at the Church of God of Prophecy, located at 85 E. 165th Street,
from June 16th through November 10th.
Food Stamp/SNAP Benefit
Payment Plan
Household Income Below
$25,000
Household Income
$25,000 - $35,000
Household Income
$35,000 - $50,000
Household Income
Above $50,000
-










$128 Whole Share in SNAP payment only
$64 Half Share in SNAP payment only
$307 Whole Share
$151 Half Share
$380 Whole Share
$187 Half Share
$440 Whole Share
$230 Half Share
$504 Whole Share
$255 Half Share
C. Fr u it Sh ar e (or d er on l y if yo u ’ ve p u r ch a sed a ve ge tab le
sh ar e )
Fruit shares run for 22 weeks beginning June 10th. Full shares are picked up
weekly and half shares are picked up every other week.
Food Stamp/SNAP Benefit  $70 Whole Share in SNAP payment only
Payment Plan
 $37 Half Share in SNAP payment only
Household Income Below
 $146 Whole Share
$25,000
 $78 Half Share
Household Income
 $192 Whole Share
$25,000 - $35,000
 $99 Half Share
Household Income
 $220 Whole Share
$35,000 - $50,000
 $114 Half Share
Household Income
 $244 Whole Share
Above $50,000
 $125 Half Share
D. To ta l Am ou n t Du e
CSA members join with their farmer in both the risks of farming (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 7-10 different seasonal vegetables, and that there is no
guarantee on the exact amount or contents of my share. 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 up!
Signature: ______________________________
Date: _________________________________
G. Vo lu n te er Agr eem e n t
Vegetable Share
$
Fruit Share
$
Donation
$
Please note that no goods or services were rendered in exchange for this
contribution and therefore this gift is fully tax-deductible in accordance
with Federal law.
Total
As a member, I commit to supporting the farm through timely payments,
and I commit to supporting the CSA by completing 4 hours of volunteer
time over the 2015 season, either through two-2 hour shifts at the
distribution site or in another way. I understand that any week I don’t pick
up my share, my food will be donated to the Church of God of Prophecy
food pantry and soup kitchen and given out to its patrons.
$
E . P a ym en t Op ti on s for Ab o ve To t al
Full Payment Enclosed
My household will satisfy the 4 hour volunteer commitment during the 2015
season by (select at least one option below):
 Helping at distribution: Where help is needed most! Volunteers will sign up
for 1-, 2-, or 4-hour shifts on Tuesdays at Grand Concourse Seventh Day
Adventist Temple.
 Contributing to the Newsletter: These are preferably people with
professional writing and/or photography experience.
 Helping with Outreach: This may include creating flyers/brochures,
contacting community organizations and more.
 Helping with a Group Activity/Event: Tasks may include contacting
neighborhood venues or creating flyers/brochures.
I’d like to help the CSA Core Group run the Bronx CSA. Please
contact me about how I can get involved!

Amount Enclosed 
How did you find out about us?
Payment Plan - 10% minimum deposit required at time of registration
Make check or money order payable to “NYCCAH” and mail it
with this form by May 12 to:
to secure your share; full payment due by May 12, 2015.
Amount Enclosed 
Food Stamps/SNAP - 10% deposit required at time of registration to
secure your share. Remaining portion paid weekly during the season with
Food Stamp/SNAP Benefits. Weekly SNAP payments after 10% deposit:
Vegetable Only: Full - $5.25 Weekly; Half- $5.25 Bi-weekly
Fruit: Full- $2.90 Weekly; Half- $3.03 Bi-weekly
New York City Coalition Against Hunger
Attn: Carrette Perkins
50 Broad Street, Suite 1520
New York, NY 10004