Phillip & Missy Jensen family 6333 300th Street, Ida Grove, IA 51445 515.460.4192 [email protected] prairiewholefarm.com SUMMER CSA SHARE 2015 Membership Sign-Up Form Become a Member of Prairie Whole Farm and receive a weekly box of fresh, local, and organically grown vegetables, herbs, and flowers. Name(s):__________________________________________________________________________ Address:__________________________________________________________________________ Phone Number(s):__________________________________________________________________ Email(s):____________________________________________________________________________ Your Share Size: ___ Full Summer Share $400 [2-4 people. $25/week for 16 weeks] ___ Half Summer Share $250 [1-2 people. $15/week for 16 weeks] Distribution Details: Visit our NEW website: www.prairiewholefarm.com LIKE and FOLLOW our Facebook page: www.facebook.com/PrairieWholeFarm ___ Pick-up at The Farm on Tuesdays from 5:00 p.m. to 6:30 p.m. ___ Pick-up in Ida Grove (location TBD) on Thursdays from 5:00 p.m. to 5:30 p.m. - Add $50 to above share price for Ida Grove pick-up. ___ Home Delivery on Thursdays (must be within 15 minutes of The Farm) - Add $100 to above share price for Home Delivery. *16 weeks -- anticipated dates from June 2/4 to September 15/17. **Please arrange for someone else to pick up your share if you are on vacation or unable to make it for pick-up. Prairie Whole Farm T-Shirt: ___ Quantity ($20/each) ___ T-Shirt Size(s) [Grey, cotton t-shirts with a large and centered Prairie Whole Farm logo pictured above.] Payment Option: ___ Pay in Full ___ Pay in 2 installments: (Pay 1/2 now and supply a post-dated check for the other 1/2, dated April 15) I am committed to sharing in the benefits & risks of this partnership with Prairie Whole Farm. I trust the farmers will do their best to provide a varied & consistent selection of produce throughout the 16-week harvest season. I understand that the number of items and selection may fluctuate throughout the growing season due to weather and other unforeseen causes. **Please note Prairie Whole Farm assumes no responsibility for member’s safety while at Prairie Whole Farm, visiting or volunteering** Signature:____________________________________________________________ Date:_________________ Please make checks payable to Prairie Whole Farm and mail form to: Prairie Whole Farm, 6333 300th Street, Ida Grove, IA 51445 E-mail:_