Rare Earth Farm 2010 Agreement Form                                                                     

Complete this form and return it with your payment to the address printed below. A confirmation

letter will be mailed out to you immediately upon our receiving this form.

Important! Please contact us if you don't receive this letter within 10 days after mailing this information.

___________________________________________________________________________________________________                           Name                            Please Print                          Date              Phone No. (required)

_______________________________________________________________________________________

Street                                    City                 Zip              Preferred drop-off

e-mail address: ____________________________________                              New Member

                                     (e-mail address required for egg share sign-up)                     Returning Member

Check the appropriate box(s) 

Vegetable share:                                   

 I would like to receive one share of the 2010 vegetable harvest.

      Enclosed is $530.00.

Egg share:   Sorry! Our egg shares are sold out. Please notify somewhere on this form if you're

                            interested in getting onto a waiting list in the event they become available.

 I would like to receive along the vegetable share, one dozen eggs every week

totaling 21 dozen for the season. Enclosed is $68.25 plus payment for the vegetable share. 

 I would like to receive along the vegetable share, one dozen eggs every other week

totaling 12 dozen for the season. Enclosed is $39.00 plus payment for the vegetable share.

Total Enclosed_____________

Note for those splitting shares: It is not necessary for us to have both parties names assigned to one

membership. The name as it appears at the top of this form will be the only name entered into our database

records. Consolidate and make any group payments with one check only and clearly identify the primary

shareholder's name on it.

 ** If you choose to make a partial payment, your final payment needs to be received by May 1st to stay

enrolled in the program.

                                                    Formal Agreement

I want to participate in the 2010 CSA program at Rare Earth Farm. In submission of this form I accept all

conditions and terms of this program. As a subscription member I fully accept sharing the risk of crop

failure from all factors beyond the farmers control knowing it may affect the availability of certain

crops and the amounts that I'll receive throughout the season.                    

                       Make checks payable and return to: Rare Earth Farm

                                                            c/o Steve Young

                                                               6806 Hwy KW

                                                   Belgium, WI 53004    

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