FDC 2011 Enrollment Form

2011 Enrollment Form

If you wish to join Marblehead or Melrose, please use this form ONLY if you have paid your $100 deposit and know you have a spot reserved for 2011. There is a waitlist for both of these locations. If you wish to join Salem, you can send in your deposit and submit this form immediately. Please direct enrollment questions to .

Name:

Address:

City/Town:

State:

Zip:

Phone:

The FDC uses email for the majority of its communication and billing. Please provide an address you check regularly.
If you do NOT use email, please write NO EMAIL in the space provided.

Email:

I would prefer to pick up a paper copy of the newsletter at the depot.
(All others will be sent via email.)

I would like to pick up my share in: (choose one)

Marblehead

Melrose

Salem

I would like to pick up on: (choose one)

Tuesday

Thursday

I would like to donate to the Community Assistance Fund. This fund helps make the FDC affordable to those in need, and makes food donations to local shelters and food pantries. ANY AMOUNT HELPS! Demand is high this year.

$5 $10 $25 $50 $100 $200

Share Type
Please check all that apply. The membership fee must be paid each year. It helps to cover the cost of running our organization.

	Organic Vegetables - Small	$200
	Organic Vegetables – Large	$330
	Non-organic (IPM) Fruit – Small	$145
	Non-organic (IPM) Fruit – Large	$210
	Chef's Share (formerly Herb Share)	$45
	Organic / Local Cheese	$75
	November Share (formerly Extended Season)	$65
	December Share (formerly Winter Share)	$65
	Bread Share (19 deliveries)	$75
	Home Delivery Each Week (limited delivery range)	$80
	Membership Fee (this MUST be checked)	$50.00 (mandatory)
	Your total is:
	(Note: Total can not be changed by the visitor.)

Billing
In addition to submitting the information on this form, a deposit of $100 is also needed to secure your membership. Your registration is NOT complete until we receive this payment. Checks should be made out to the FDC and mailed to FDC, Box 1146, Marblehead, MA, 01945. You may pay in full at any time. If you choose to pay in installments, the 1st payment of half the balance is due by June 30th. The final balance is due in full by August 31st. Any purchases or add-ons made after August 31st are due immediately. Late fees are applied monthly to delinquent accounts. Billing questions can be addressed by calling 1-877-FDC-FARM extension 13, or by emailing .

Volunteering:
Each member is urged to volunteer for at least two hours during the season. Please indicate your preference for volunteer activities.

depot work

organize field trip or event

write for newsletter

delivery shares

depot improvements

serve on board

website

I have an extra fridge to store cheese or cranberries

other

I was referred by