Upper Meadows Farm CSA 2009 Agreement

I, ______________________________________, have read both the “CSA Agreement Terms” and “CSA Agreement” in their entirety, and do unconditionally agree to the “CSA Agreement Terms”. I further understand that upon my written request I will be entitled to a refund for my subscription expense minus 10% administrative cost until 17 June 2009, after which time no refunds will be given. I agree that I am solely liable for my actions and the actions of my dependants or companions while entered upon lands or market booths managed by Upper Meadows Farm/Leonard Pollara. Furthermore, I unconditionally do hold harmless Mr. Pollara, his family, employees and assigns for any and all accidental loss of any type that may occur while I am a guest on farm or at market. While on farm I unconditionally agree to follow all directions, rules and requirements as explained by Mr. Pollara and his employees or assigns. I understand that I will be expected to leave the premises promptly if asked to do so and agree to this in advance. My signature below attests to my voluntary agreement to the foregoing in its entirety.

Signature: __________________________________ Date: _______________________
Upper Meadows Farm CSA strongly recommends that new members attend at least one of our informational meetings. Please inquire as to date and location. CSA is not for everyone and these meetings provide you a better chance to consider your needs in light of our CSA.

Please give us your complete contact information. [Renewing members indicate changes only]

Mailing Address:__________________________________________________________


Telephone:_______________________________ Fax:_________________________

Cell Phone:________________________ e-mail_______________________________

Share preference:

Premium Executive ____




Payment method: Check_____  Cash____  Credit Card____  Payments_____  Other_____

I would like to donate $_____ to the Revolving Loan Fund.

I have added $______to my check to contribute to the Revolving Loan Fund.

Pick-up time and location, circle one:
THURSDAY(on farm 4-7pm) or (Ashley Farm in Flanders 4-7pm)
SUNDAY(Verona 12:30pm – 1:30pm)(Sparta, 2:30pm-3pm)
SATURDAY(W43rd between 9th and 10th Avenues 10:30am-12:30pm)

Please select this panel, print and fill out the “Agreement” [this form] and submit with your payment to complete your application. Please retain a copy of the completed form for your records.


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