Blue Gate Farm CSA

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Blue Gate Farm CSA

2023 Membership Form

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* Indicates required question

Email *

Your email

Last Name *

Your answer

First Name *

Your answer

Street Address *

Your answer

City *

Your answer

Zip *

Your answer

Phone #1 *

Your answer

Phone #2

Your answer

Email (alt#1)

Your answer

Email (alt#2)

Your answer

Pick-Up Location *

Des Moines

Knoxville

on farm

# of Base Produce Memberships ($650) *

1

2

Are you splitting this share with another household? *

Yes

No

If you are splitting your box, please include their name, phone # and email below

Your answer

Next

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