2012 Rolling Prairie Membership Form

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Please read the following. If you agree, use the Print command on your browser to print the form, then fill in the information. New subscribers pay a $85 deposit and receive a copy of our Rolling Prairie cookbook. Previous subscribers pay a deposit of $75.  Mail the completed form with your deposit check made out to Rolling Prairie to the Site Coordinator for the site where you choose to pick up your bag.

I have read the information on the Rolling Prairie web page and understand that I am responsible for picking up my bag each week. I understand the price of each weekly bag is $17 or $14 for the economy bag at Local Burger (including sales tax) and that I will be billed monthly with payment due on the first pickup each month. I also understand that my membership is not activated until the site coordinator receives my deposit check. I understand that the equivalent of three weeks' bags will be applied towards my last bill, with the remainder to cover a portion of the operating expenses of Rolling Prairie Farmers Alliance.

Name _______________________________ Which pick up site and day would you like to use? (Click here for details on sites & times.)
Address _______________________________ __________________________________________
City _______________________________
Are you a returning member?
Zip ____________ How did you hear about Rolling Prairie?  
Email Address _______________________________
For Lawrence Members- Would you like to participate in
the Early Bag (usually middle of April-beginning of May)__________

the Late Bag ( last reg. pickup- End of Nov)?_________
Home Phone _______________________________

Work Phone _______________________________ Comments or questions?

 

Site coordinator addresses:

Lawrence Mondays (regular bag): 4:00-6:30pm Bob Lominska, 1954 Union Rd, Lawrence, KS 66044
785- 842-5697, rlominska@wildblue.net
Lawrence Thursdays (economy bag): 4:00-6:00pm Paul Johnson, 3960 Ridge Dr., Perry KS 66073
785- 597-5858, pdjohnson@centurylink.net
JCCC Wednesdays
4:00-6:00pm		 Stu Shafer, 3213 Buck Creek Rd., Oskaloosa, KS 66066
 785- 691-5006, sandheron@rollingprairie.net
Roeland Park CC, Wednesdays 4:30-6:30pm
Roeland Park Community Center,
Wednesdays 4:30-6:30 pm
4850 Rosewood Drive in Roeland Park KS.

 Paul Conway, 25476 183rd St., Leavenworth, KS 66048
913-775-2559, pconway@wildblue.net

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