2016 CSA SIGN UP Download 2016 Blue Heron Farm CSA Brochure Name* First Last Email* PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code What type of CSA share would you like?Full Share - $650Individual Share - $450Pro rated - Summer ResidentSalad Share - $200, Farm Pickup OnlyFinancially Supported ShareWhat type of Financially Supported Share are you interested in?Full ShareIndividual ShareWe rely on the honor system to offer our CSA shares at a reduced cost. If you are in need of financial assistance beyond the prices below, please fill out this form: https://www.blueheronfarmvt.com/application-for-financially-supported-csa-shareChoose a sliding scale amount to pay for a Full Share$575$600Choose a sliding scale amount to pay for a Individual Share$375$400What type of pro-rated share would you like?FullIndividualSummer Resident - Full$40 per week, enter number of weeks. Price: $40.00 Quantity: Summer Resident - Individual$25 per week, enter number of weeks. Price: $25.00 Quantity: For those who would like to access our honor system sliding scale:Full Share $575Full Share $600Individual Share $375Individual Share $400No, thanksDo you want a Certified Organic Egg Share?1 dozen per week $108half dozen per week $54NoDo you want a Certified Organic Chicken Share?$50 deposit, $5.75 per lb5 birds10 birdsNoDo you want a Wally's Place Bread Share?18 weeks $100, THURSDAY DELIVERY ONLYYes - 18 weeksNoDo you want off-farm delivery?*YesNoWhere should your CSA be delivered? UVM Medical Center Northwestern Medical Center, St. Albans St. Alban's City Hall Rail City Market - St. Albans Milton - TBA Other Enter Other Delivery Location:Will you be participating in a working share?Deducts $50.00 from share cost – 5 hrs of work per monthYesNoWould you like to make a contribution to the VT Farm Share For Blue Heron Supported Shares?YesNoEnter Contribution Amount Would you like to make a contribution to Food For Thought produce - Summer lunch program?YesNoEnter Contribution Amount Please check that you read all the statements below before continuing to payment.* I am sharing in the reward & risk of my CSA membership as described on this brochure. I understand that I must pick up my CSA share on the appropriate dates & times or my share may be donated. I understand that this CSA has an honor system sliding scale and will respect it. I understand that the farm will send important communications to me via email. Processing Fee Price: $10.00 Total $0.00 NameThis field is for validation purposes and should be left unchanged.