2009 Rolling Prairie Membership Form

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NOTE- The JCCC site and the Merc site are full. To join the waiting list, fill out and submit the application, but don't send deposit.  You can bring that if we are able to accomodate you later in the season.

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 $80 deposit and receive a copy of our Rolling Prairie cookbook. Previous subscribers pay a deposit of $70.
 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 $16 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 (Mid- April- 1st Regular Bag)?______

Or the Late Bag ( last reg. pickup- End of Nov)?_____

Home Phone _______________________________

Work Phone _______________________________ Comments or questions?

 

Site coordinator addresses:

Lawrence Mondays (regular bag): Bob Lominska, 1954 Union Rd, Lawrence, KS 66044
Lawrence Thursdays (economy bag): Paul Johnson, 3960 Ridge Dr., Perry KS 66073
JCCC Wednesdays Stu Shafer, 3213 Buck Creek Rd., Oskaloosa, KS 66066
Franklin Center, Wednesdays
Paul Conway, 25476 183rd St., Leavenworth, KS 66048

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