2010 Lehigh Valley Food Cooperative Registration

Thank you for your interest in becoming a member of Lehigh Valley Food Cooperative. Lehigh Valley Food Cooperative customers and producers are interested in local foods and products produced with sustainable practices that demonstrate good stewardship of the environment. To become a member, please read the Terms of Service, and then complete the following information and click submit.

If you are already a member, please sign in here. Otherwise fill out the form below to become a member.

Section 1: General Information
First Name: Last Name: First Name 2: Last Name 2:
Business Name:
Section 2: Contact Information
Address: Address 2: City/State/Zip:   County: Do Not Send Postal Mail:
Work Address: Work Address 2: City/State/Zip:
Home Phone: Work Phone: Mobile Phone: FAX: Toll Free:
Email Address: Email Address 2: Home Page: http://
Section 3: Access Credentials
Username: Enter the word Human validation text Password: Confirm:
Section 4: Membership Type
Membership Type: Choose One Purchasing member (1-4 hours) Producer member Purchasing member (0 hours) Purchasing member (5-7 hours) Purchasing member (8+ hours) Purchasing member (1-4 hours) $100.00 plus $25.00 annual fee thereafter, waived the first year. Will volunteer 1-4 hours per month. Producer member $125.00 plus $25.00 annual fee thereafter, waived the first year. Purchasing member (0 hours) $100.00 plus $25.00 annual fee thereafter, waived the first year. Will not be able to volunteer (+15% to purchases) Purchasing member (5-7 hours) $100.00 plus $25.00 annual fee thereafter, waived the first year. Will volunteer 5-7 hours per month (-7% off purchases). Purchasing member (8+ hours) $100.00 plus $25.00 annual fee thereafter, waived the first year. Will volunteer eight or more hours per month (-12% off purchases).
Section 5: Additional Information
How you heard about Lehigh Valley Food Cooperative: Choose One Newspaper article Magazine Online Friend or Family Flyer or Booth Other Please give more detail: What website, from whom, which publication/date, etc.?
YES! I‘m interested in volunteering to help Lehigh Valley Food Cooperative.
I acknowledge that I have read and understand the Lehigh Valley Food Cooperative Terms of Service statement.
I am interested in becoming a producer member for Lehigh Valley Food Cooperative.