Mendocino Renegade
Renewal Application for 2024
Name
*
First Name
Last Name
Farm Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Website
Has there been a change in the number of acres?
*
Yes
No
If so, what is the the new acreage?
Farm Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different than farm address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have there been any significant changes in your operation, for example: vegetables to livestock, or a significant change in practices? If so, please describe the change.
Please upload or attach a plot plan of your facilities or farm IF SIGNIFICANT CHANGES WERE MADE from last year
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Have you added or dropped vegetables or livestock? Please list
Have you made any significant changes in the off-farm inputs you use? If so we will send you an Off-Farm Inputs Report form to fill out.
Changes in off-farm inputs?
Additional information, comments, or questions about anything.
Do you need a Renegade metal sign?
Yes, please send me one
Don't need one
Do you want any brochures to hand out to customers? (If yes, please specify how many.)
I understand that I am solely responsible and liable for any illness or problems resulting from my products sold to consumers, regardless of whether they are certified Mendocino Renegade or not. I understand that the information provided in this applications is accurate and true. Furthermore, I understand that any misrepresentation of the farm or business described herein will be grounds for denying my application and/or removing my farm or business from the Mendocino Renegade certification program. I have read and understand all standards documents and the materials list.
*
I agree
Date
-
Month
-
Day
Year
Date
Signature
*
My Products
*
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Membership Renewal
$
75.00
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