Spiral Path Farm Central PA CSA Membership

_-REGISTRATION FORM

If you’d like to become a member of Spiral Path Farm CSA, please fill in your information and sign the form below. Mail your registration form and payment to:

Spiral Path Farm • 538 Spiral Path Lane • Loysville, PA 17047

Name: ____________________________________________________________________________________

Address: __________________________________________________________________________________

City: ___________________________________________ State: ____________ Zip: ____________________

Phone: __________________________ Email Address: ____________________________

� New Member � Member Renewal First Delivery May 16^th** Last Delivery November 21

After May 10 – Registrations received after May 10 will be pro-rated to reflect the reduced number of deliveries. After May 10^th, registration and payment must be arrive via Paypal at the website or at our mailbox by Friday afternoon to receive a CSA box the following Wednesday.

Please select your share option & payment plan:			Payment per share	Subtotal
FULL SHARE – a delivery every week (28 weeks total)
___ Early Bird	$531.00 - payment by April 1, 2007	#_____	X $531.00 per share	$_________
___ Full Payment	$590.00 - payment after April 1, 2007	#_____	X $590.00 per share	$_________
___ Installment Plan	$590.00- per share $140.00 deposit	# _____	X $140.00 deposit	$_________
payments of $150.00 due June 1, July 1, August 1
Call or visit website for pro-rated prices after May 10, 2007.
� MEDIUM SHARE – a delivery every week (28 weeks total)
___ Early Bird	$350.00 -payment by April1, 2007	#_____	X $350.00 per share	$________
___ Full Payment	$390.00 -payment after April 1, 2007	#_____	X $390.00 per share	$________
___ Installment Plan	$390.00-per share $100.00 deposit	#_____	X $100.00 per share	$________

Payments of $100.00 due June 1, July 1 and $90.00 due August 1

Please make checks payable to Spiral Path Farm. Credit card payment option available only on website.

TOTAL AMOUNT DUE $_________

CSA SHAREHOLDER AGREEMENT

I understand that my payment entitles me to a weekly share of fresh, Certified Organic produce harvested at Spiral Path Farm. I also understand that I am making a commitment to Spiral Path Farm CSA, and recognize that since there is no guarantee on the exact amount of produce I will receive for my share, I will share both the rewards and the risks of the growing season along the other members and farmers. It is my responsibility to pick up my share within scheduled distribution hours (8 AM to 9 PM on Wednesdays) or contact my host, and that if I do not, my share will be donated elsewhere. I also understand that my share payment is non-refundable.

Signed: ___________________________________________________

Select Your Pick Up Site (Circle One )

WEST SHORE SITES

___ Boiling Springs – Lerew Rd. -Petra Wirth Yoga Center ___ Camp Hill – Country Club Park- Round Hill Rd. ___ Carlisle – N. Hanover Street ___ Enola- N. Enola Drive- The Leaf of Eve ___ Grantham - RT15 & Lisburn Road___ Lemoyne - State Street __ Mechanicsburg – S. Market-The Rosemary House___Newport - 2nd Street-Expresso Yourself Cafe ___ New Cumberland - 3rd Street

___ Orr’s Bridge Rd Area – Candlelight Dr. ___ ShermansDale – Rt 34- Kruba Chiropractic ___ Spiral Path Farm

EAST SHORE SITES

___ Colonial Park – Rt 22- Gault Chiropractic ___ Harrisburg – N. 2nd St.-The Movement Center___ Hershey#1- Zurich Drive ___ Hershey # 2 Location TBA ___ Palmyra - W. Main St. The Cinderellla Shoppe ___ Progress Avenue – Progress & Schoolhouse-Schappell Chiropractic ___ Union Deposit Road- Briarsdale & Union Deposit-The Family Wellness Center

We will mail you a letter to confirm your membership and delivery site. Please feel free to contact us with any questions.