MEMBER INFORMATION o School Staff! Name/s:
Please include names of all people sharing membership

o Family of Student! !

o Community Member!


Address: Phone: Email:

We believe that all people, regardless of their income level deserve beautiful fresh flowers. Therefore, we have a sliding scale cost for our Flower Share based on your income level & family size. We ask that you be generous and pay within your means. We suggest that individuals earning less than $30K give at the medium level, and $40K at the higher level. Individuals and families on public assistance or part of HSPS please feel free to join at the lower cost.

CSA membership fees are NOT tax-deductible.

MEMBERSHIP LEVEL: o $150, Low Cost Share o $160, Medium Cost Share o $170, Higher Cost Share PICKUP LOCATION:

PAYMENT OPTIONS: o Full Payment: Include a check for the total share cost
o Installment Plan: Include 2 checks or money orders for 1/2 the total cost, one dated today and one dated August 21st.

o WEDNESDAY afternoon at the Youth Farm (600 Kingston Avenue)

o MONDAY evening at Shambhala Yoga (367 St. Marks Avenue)

I commit to membership in the 2011 Youth Farm Flower CSA. I will pick up my share every week on Wednesday from June 24 through October 14, at the location I have selected above. If I am unable to pick up my share, I will have a friend or relative pick up for me, or forfeit my share that week. I understand that CSA involves sharing the rewards and risks with the farm. I understand that my share may vary from week to week, and that there is no guarantee of the exact amount of my share. I agree not to hold Green Guerillas, the High School for Public Service, BK Farmyards, or anyone acting on its behalf, including any agents, officers, volunteers or employees, responsible for any damages resulting from injuries sustained while engaged in any event or activity, including but not limited to weekly distribution or volunteer days. I hereby authorize Green Guerillas and HSPS to use, reproduce, and/or public all written and/or visual materials, including photographs, that may pertain to me. I understand that this material may be used in various publications, public affairs releases, recruitment materials,

or for other related endeavors. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Through membership in the HSPS Youth Farm CSA I am supporting a local food system and bringing healthy food to our community. I have read this agreement and agree to the terms:






Please make checks payable to: Green Guerillas Please write “CSA” in the memo line. Mail application and checks to: Green Guerillas 232 E. 11th Street New York, NY 10003
Membership is granted on a first-come, first serve basis with preference given to HSPS parents.

For more information, visit www.hspsfarm.blogspot.com

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