Central Oregon Locavore
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Membership Form - Monthly
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
Monthly Membership Amount
*
$
Payment Schedule
Monthly
Add 3% to my total amount to help cover the payment processing fees