Central Oregon Locavore
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Membership Form - Annual
Contact Information
Name
*
First Name
Last Name
Organization
Company/farm/ranch name, if applicable
Phone
*
Spouse/Partner Name
First Name
Last Name
Email
*
Verify Email
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Membership Level
*
$50
-
Seed (Only for Vendors Membership)
$75
-
Sprout
$125
-
Row
$250
-
Garden
$500
-
Cultivators Club
Payment Schedule (Yearly will automatically renew)
Yearly
For Sponsor Business Employees, please enter the name of your company.
Company Name
Name of Staff Member Who Helped You
*
select one
Birke
David
Dawson
Felicia
Jamie
Jay
Kaitlin
Kim
Leighana
Lexie
River
N/A
Add 3% to my total amount to help cover the payment processing fees