Grower / Food Producer Sign-up Form

This is an abbreviated online signup form for Grower Members.  Signed PLEDGES are required, along with your payment, to finish processing your membership.  You can download all necessary forms at http://kcfoodcircle.org/membership/grower-membership/#FORMS

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Secure electronic processing of your KC Food Circle membership is now available -- if possible, please make your payment using our PayPal page (you will be taken to our PayPal page when you complete the form below).

You may also pay by personal check (make checks payable to HAAL* with a memo: "KCFC Dues")

Whatever payment method you choose, please fill out the following form.

PRINTING: BEFORE YOU CLICK on the SUBMIT button, press CTRL-P (or APPLE-P) to print a copy of this form for your records - please include a hard copy in your mailing when paying by check.

* The Kansas City Food Circle is a long-term (over 20 years)
project of The Heart of America Action Linkage (HAAL), our
parent 501c3 organization.

NOTE: Your private contact and payment information will only be used for Kansas City Food Circle membership processing, and it will never be shared with any third party for any reason.

Please note: If you are not automatically redirected to Paypal after completing your membership subscription form, click here to make your $40 payment online. Your subscription is not complete until you make a payment.

If you experience any trouble filling out or submitting this form, please call Dave Lawrence at 913-620-8427 for support.

* (denotes required field)

NAME USED on PayPal/Credit Card (or enter "Paying by Check")*

E-Mail Address:*

E-Mail Address again:*

Please enter your E-mail Address a second time.

Please edit, replacing {Farm Name} in the space provided:

TYPE / Farm Name:*

You may enter more than one phone number here - please make your primary phone number the first one listed.

Primary Phone / Secondary Phone*

STREET*

CITY*

STATE*

ZIP CODE*

Leave this field unchanged if you wish to HELP US SAVE valuable resources and minimize postal mail from the KC Food Circle - otherwise, replace it with the word "NO" and we'll send you newsletters and other essential or seasonal communications by postal mail.

MAKE MY MEMBERSHIP ELECTRONIC

Your Full Name (for our Contact List)*

Personal Note:

Enter the characters shown in the graphic above. If you cannot read the code, click the little refresh button at the top-right of the graphic image.*