Print Name: ______________________________________________________________

Phone #’s:  Home/Work: ________________________Cell: _________________________

Address: ________________________________________________________________

Email Address: ____________________________________________________________
                                                                        —please write NEAT!!—
Membership type:
______ Renewal          ______New Member (Referred to by: _________________________)

Other than yourself, who do you authorize to pick up your CSA basket?
______________________________________________________________________

**NOTE: We will contact our CSA members, via email, with weekly pick up reminders.  If email
is not an appropriate means of communication for you, please check here ____________

2012 CSA Options: (all options are for 18 weeks of homegrown produce)
FULL SHARE:  $500…Deposit of $50 due before 4/01/12…Full payment due before 4/15/12
HALF SHARE:  $320…Deposit of $50 due before 4/01/12…Full payment due before 4/15/12
**NEW FOR 2012** —
PERSONAL SHARE: $250…Deposit of $50 due before 3/01/12…Full payment due before 4/15/12

Please check all that apply:
CSA OPTION:      ______Full Share     ______1/2 Share     ______Personal Share
PAYMENT OPTION:    ______Cash     ______Check     ______Credit Card (Visa/MC/Discover)
PAYMENT METHOD:    ______Paid in full     ______Deposit     ______Payment
                                   ***Please make all checks payable to VonThun Farms***

_________________________________________     _________________
                               CSA Member Signature                                                              Date

RETURN THIS APPLICATION TO US ANY WAY YOU CHOOSE!

~Email:  Cindy@VonThunFarms.com
~Fax: 732-329-0439
~US Postal mail:  VonThun Farms, 519 Ridge Road, Monmouth Junction, NJ 08852