Gathering Together Farm 25159 Grange Hall Road, Philomath, OR, 97370 phone: 541-929-4273 fax: 541-929-6007 www.gatheringtogetherfarm.com email:
[email protected]
2016 CSA Registration Form **If sharing a box, please include contact info for other members on the back.
Name _____________________________________________________________ Address ___________________________________________________________ City ________________________________________ Zip ___________________ Phone ______________________ E-mail (please print clearly) ____________________________________________ I would like to receive my confirmation letter (choose one):
By email
By snail mail
Newsletter Option Weekly newsletters will be emailed to all members. Would you also like to receive a paper version at your pick up site? (Choose one): Yes, send one for me! No, thanks
I will pick up at (circle one):
Corvallis Neighborhood near Fred Meyer Tuesday 4:30pm-6:30pm
Corvallis Wednesday Farmers Market
Corvallis Saturday Farmers Market
Philomath Farm Stand- between Tuesday 3:30pm until Thursday evening
Portland Wednesday Farmers Market
Moreland Wednesday Farmers Market (Market ends mid-October and will require an alternate pickup site for the duration of the season)
Portland, Irvington Neighborhood – Tuesday AM (This location can only accommodate the first 30 members)
Portland, Laurelhurst Park NeighborhoodTuesday AM (This location will supplement the Irvington neighborhood pickup)
Payment Options (circle one): $525 before April 1st ($550 for Yachats members)
$550 April 1st or later members)
($575 for Yachats
$105 initial payment and four monthly payments of $105 (postdated checks for April, May, June, and July should be sent with the initial payment and will be cashed on the 1st or 15th of each month). After April 1st, please include an additional $25.
Salad Options (circle one):
None
$60 Salad Lovers (2/3-lb bag twice/month)
$110 Salad Addicts (2/3-lb bag every week)
Beaverton Saturday Farmers Market
*Please consider a donation of $15 to the GTF
Newport Saturday Farmers Market
Hillsdale Sunday Market
Yachats – Saturday (This location has a $25 surcharge to cover delivery)
CSA scholarship fund, which will be used to buy up to 50% of shares for low-income families. Contact us for more info.
For directions and times to the Farm and to all Market pickup locations, please visit our website at: www.gatheringtogetherfarm.com, or call or email us. The neighborhood pickup addresses will be given to you once we receive your registration form and payment.
Total Amount Due: _________ Please send checks to: Gathering Together Farm 25159 Grange Hall Rd Philomath, OR 97370
