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2011 Hill Community Supported Market (CSM) Sign-up Form

1. SELECT THE TYPE OF BAGGED SHARE YOU WISH TO RESERVE


Market Share.$13.00 per week Subsidized Share..$6.00 per week
for CMHC & CSN clients and CSN agencies & programs

What is in a share? Here is a sample from last August. August Sample Share 4 red lodi apples 4 ears of corn 1 bag of lettuce 2 cucumbers 1 bulb of fresh garlic

WIC or SNAP Share..$6.00 per week*

Price of share includes farm fresh produce, packaging and handling of share and CSM newsletter with recipes, preparation and storage tips. Shares will be available for you to pick up each Friday from July 8 October 28 between the hours of 12:00 pm2:30 pm at the Connecticut Mental Health Center, 34 Park Street. *Those with WIC or SNAP shares pay weekly at the CitySeed table each Friday between hours of 12:00 pm 2:30 pm.

2. DONATE TOWARDS A SHARE (NOT REQUIRED)


I would like to contribute:

a weeks share.. $13.00 other .......$_________

Donations will go towards offsetting the cost for people in recovery who want to eat fresh food but cant afford to buy it!

3. TOTAL COST
_____________ X 17 weeks $____________ Cost of Share + Donation Amount....$____________ Total.......$____________

4. PLEASE PAY WITH A CHECK MADE OUT TO:


(EXCEPT FOR THOSE WITH WIC OR SNAP SHARES*)

CitySeed, Inc.
817 Grand Ave., New Haven, CT 06511

If there are any questions about payment contact Ashley Kremser at CitySeed (203.773.3736) *WIC or SNAP share recipients should pay weekly at the CitySeed table each Friday between hours of 12:00 pm 2:30 pm

To reserve a share, please pay for the entire season in advance unless you are using WIC/SNAP benefits.

Name:_______________________________________________ Organization Name:__________________________________ Email (frequently checked): _______________________________

Address:_____________________________________________________________________ Phone: Home___________________Work__________________ Cell__________________


The best way to reach me is (please circle): EMAIL HOME PHONE WORK PHONE CELL

5. RETURN THE CHECK AND THE FORM TO:


Sharon DeGenaro, CSN Senior Admin. Assistant, 34 Park St., Suite 144, New Haven, CT 06511
Questions? Please contact Sharon DeGenaro at the CSN 203-974-7082 or sharon.degenaro@yale.edu May2011