One Community Grocery Co-op Membership Application

One Community Grocery Co-op
Membership Application
One Community Grocery Co-op exists to provide health and economic equity to the South St. Petersburg community and its members through co-op membership, education, and providing healthful and locally grown food
MEMBERSHIP APPLICATION
Name or Organization

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Cell Phone
Current address
City
County
Postal Code
SPOUSE INFORMATION IF JOINT MEMBERSHIP
Name
Phone
Email
example@example.com
CHILDREN IF MEMBERSHIP PRIVILEGES DESIRED
Name
Name
Name
Name
I WISH TO BECOME A CONSUMER MEMBER

I have included a minimum down payment of $25.00 of my $225.00 and pay $25.00 a month for 8 additional months

I have included a payment in full of $225.00

I wish to make a contribution only or in addition to my membership

- WISH TO HELP ON A COMMITTEE
Please select one
List any skills you have and want to share
I WISH TO BECOME AN ORGANIZATIONAL MEMBER
We have included a minimum donation of $50 in addition to our $225.00 membership
YES
NO
Organization name
I understand my membership will not be accepted without a valid e-mail address and mailing address. My membership fee is refundable, and I agree to alert the co-op of any changes to my personal information
Signature

Clear
Date

MonthDayYear
Date
Signature of spouse (only if for a joint membership):
Signature

Clear
Date

MonthDayYear
Date
I WANT TO GET INVOLVED AND VOLUNTEER!

(Please check areas of interest)
Type a question

MEMBERSHIPOUTREACHPOLICY/GOVERNMENTAL AFFAIRSNEWSLETTERGRANT WRITINGEVENTS/FESTIVALS/CONFERENCESLEGALEDUCATION/TRAININGPUBLIC RELATIONSWEBSITEMARKETINGINFORMATION TECHNOLOGY
OTHER (GIVE US SOME IDEAS!!)
We strive to foster a thriving local food community by: cultivating & facilitating farmer-consumer relationships; promoting the enjoyment of naturally grown, fairly priced, healthy food; and providing education & resources regarding environmentally sensitive agriculture

Make Checks Payable to the One Community Grocery Co-op

Please return your completed form with payment by mail:

One Community Grocery Co-op (OCGC)

4222 22nd Ave South #531711

St. Petersburg, FL 33711

Additional Contact Information

Phone: 727-340-0337

Email: onecommunitygrocerycoop@gmail.com

Facebook: https://www.facebook.com/pg/OneCommunityGroceryCoop
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One Community Grocery Co-op

Membership Application

MEMBERSHIP APPLICATION

CHILDREN IF MEMBERSHIP PRIVILEGES DESIRED

I WISH TO BECOME AN ORGANIZATIONAL MEMBER