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________________

 Membership Application

Name (s): _____________________________

______________________________________

Address:

(Physical)_____________________________

(mailing) _____________________________

______________________________________

Phone #:______________________________

Cell #: ________________________________

E-mail: ________________________________

Please indicate how you prefer to be contacted from the above options: ______________________________________

Write the amount next to one of the       options listed below:

  CSA Box Value $400:    __________

OR

    Farm Account 

        Value $100-$200:    __________

Please   complete  the  form   and   return with your payment option. Space is limited so do reserve your share today.

Accepting applications beginning Febuary 1st until May 1st.

Make checks payable to Holistic Homestead. 

 Please mail to :                P.O. BOX 125

                                   EVERSON, WA, 98247               

Thank  You!

Please notify me if payment options hender your realistic Budget Plan. More details upon Request.