Application for Membership
Date: _____________ Membership Name:
_______________________________________________________________
Farm Name: _____________________________________________________________________
Address: _______________________________________________________________________
City: ___________________________ State: _______________ Zip: __________________
Home Phone: _________________________ Business Phone: __________________________
Email: __________________________ Website Address: _____________________________
Children's Names and Ages: _____________________________________________________
________________________________________________________________________________
Mail this application along with your check to the Secretary-Treasurer
Secretary-Treasurer Sherry
Nesselrodt 5297 Indian Trail Road Harrisonburg, VA 22802 540
269 6403 |