CSA Membership Registration Member InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Confirm Email CSA Share SelectionCSA Shares* Full Share - $400 ($25/weekly) Half Share - $225 ($14/weekly) Bakery Share (Loaf of bread) - $48 ($3/weekly) Member Agreement* I agree to the membership terms I would like to become a member of Collins Country Greenhouse and Farm Market’s CSA program. The farmer promises to make all efforts to provide you with a season of bountiful, tasty, and high-quality produce. Every season will be different depending on the weather and growing conditions. By becoming a member of the CSA program I agree to share in the abundance and the risks along with the farmer and other CSA members. I understand that membership is a season-long commitment and I agree to pick up my CSA share at my designated place and time. This iframe contains the logic required to handle Ajax powered Gravity Forms.