2012 Greenspirit Farm CSA Membership Form

Greenspirit Farm

Andrew Kerr 4352 State Road 23 Dodgeville, WI 53533 608-574-0227 info@greenspiritfarm.com

About You - CSA Member Info.

We will not share your information with anyone -- we respect your privacy.

Your name * Go ahead and share your household members name if applicable.

Your complete address * Include street address, city, state and zip code

Your email * This is our best way to communicate

Your phone number *

Any special information, needs, or ways that you would like to participate? Anything else we should know or you wish to tell us?

2012 Share Pick-up / CSA Box Selection and Payments

This section of the form enables us to plan ahead for amounts and varieties of what we will grow. Our commitment to you is to grow your food with concern for your community, for your health and for the environment. Your commitment to us is to pick up your food at your chosen time and to participate in the farm. This could be by simply enjoying your food, sharing in the community of the farm either at box pick up or farm events, or helping out with plantings, field work, and/or harvest days. Thank you and welcome!

Share Pick-up Day and Place

Fill in the fields below to indicate where and when you would like to pick-up your share.

Choose your pick-up DAY and LOCATION * Please select your preferred delivery site/day of the week.

Would you like to make your home or business* a CSA delivery site? * Indicate "YES" or "NO", iF you would like to volunteer your home for a delivery site and *you live within 15 miles of the farm, please indicate this and we will see what we can do!

Choose which share(s) you would like

Use the options below to let us know what type of CSA share you want.

Seasonal CSA Share Options * Fill in the fields below to indicate what type of CSA share you want.

$150 @ SPRING SHARE [Spring Season - late April-late May] Four weeks of our first veggies of the season—a wonderful way to start the warm weather.
$800/season @ GRAND SHARE [Regular Season - late May-mid October] This is our FULL box for BIG veggie eaters! It is also good if you want to preserve some of the season's bounty, or share with a friend.
$500/season** @ STANDARD SHARE** [Regular Season - late May-mid October] 1/2-2/3 size of full share. This is a popular choice among many of our member families.
$300/season @ EVERY OTHER WEEK SHARE [Regular Season - late May-mid October] Standard size share prepared for you every other week.
$550/season** @ TOP TEN BOX SHARE** [Regular Season - late May-mid October] Standard size, every week, only the “favorite” veggies!
$300/season @ FULL LENGTH WINTER SHARE [Winter Season - October-December] Three pick ups of storage food (Oct, Nov, Dec)
$200/season @ SHORT WINTER SHARE [Winter Season - October-November] First two Winter Share pick-ups (Oct, Nov)

**This indicates our standard price

We would like to try an experiment with you about pricing. For some of you it is a stretch to pay for local, healthy food at a price that pays us a living wage. For others, this price is not a problem. Therefore we extend to you the option of paying as little as $450, and as much as you feel inspired to pay for your standard share based on your assessment of your ability to pay, balanced with your understanding of our right to a fair wage.

MACSAC Partner Shares Program Options Please indicate your participation in the following programs by the Madison Area Community Supported Agriculture Coalition (MACSAC)

I am interested in the Partner Shares Program, a project of Madison Area Community Supported Agriculture Coalition, which would allow me to pay half the cost of my share based on low income or special need status. To find out more about this program contact MACSAC at 608-226- 0300. www.macsac.org
I would like to make a donation to MACSAC’s Partner Shares Program to help low income families receive CSA shares (please indicate your donation amount in the "Other:" field below).
Other:

Insurance Rebate

Receive money back for purchasing a vegetable share from Greenspirit Farm! Visit http://www.csacoalition.org/our-work/csa-insurance-rebate/ for more rebate details. If your insurance provider is not listed, contact them to ask if they offer a rebate--if your provider does not offer a rebate, ask them "why not"?

Insurance Rebate Information Please select your insurance provider

For Physicians Plus, GHC, and Dean Health Plan members To receive your rebate through your health care provider, use the field below to enter "P+ Eat Healthy Rebate", “GHC-SCW Wellness Reimbursement” or “Dean W.I.N.”. Be sure to include your date of birth and member number in the field below too. Again, visit http://www.csacoalition.org/our-work/csa-insurance-rebate/ for more rebate details.

Do you need us to send you a receipt with copy of this form for the health insurance rebate? You may need a copy of this form to send to your provider with a receipt from us.

Payment Choices

After you have filled out and submitted this form, please mail your payment to Greenspirit Farm, 4352 State Road 23, Dodgeville, WI 53533. If you prefer to pay by cash call ahead to Andrew at 608-574-0227, then stop by the farm to drop off your cash payment. We only accept Checks or Cash. Please contact us with any additional financial concerns. We will try to work them out with you.

2012 CSA Membership Payment * Payment options

Full Payment. Pay everything now and be done with it! Total food options from above.
Subtract $75 - Farm volunteer. Deduct $75 for a commitment to work 6 hours over the course of the season. Many opportunities!
Subtract $500 - Work Share: Standard share of weekly produce, in exchange for four hours of labor each week from June—September.
2 Payments. Divide total by 2. Enclose two checks, one with today’s date, and one dated July 15, 2012. This spreads out the cash flow for you, and saves us nagging you in July!

PAYMENT TOTAL * Please indicate the total amount you are paying