Name *

First Name

Last Name

I am at least 18 years old *

No

Yes

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Member-Owner Equity Share Option *

One-Time Member Investment ($200)

Quarterly Member Investment (four $50 quarterly payments)

Work Equity ($25 and 15 hours volunteer commitment)

Have you participate in Shop Your Way to a Membership? *

Yes

No

Owner referral

Let us know if you were referred by a current CO-OP owner.

First Name

Last Name

What talents do you have that you are willing to share with the CO-OP?

Outreach events

Marketing

Market days

Volunteer coordinator

Vendor management

Legal

Finance