New Member Form

New Membership

Welcome! Please complete the application below and submit your equity investment. Your application will be processed within 24 hours.
Primary Cooperator (Required)*

First NameMiddle NameLast Name
Birth Date (Required)*

MonthDayYear
Address (Required)*

Street Address

Apartment Number / Street Address Line 2

CityState

Zip Code
E-mail (Required)*
example@example.com
Phone Number (Required)*
Primary Store (Required)*
Where you expect to do most shopping
Additional Household Members
Second Member

First NameLast Name
Birth Date

MonthDayYear
Email
Please include for electronic member card
Phone Number
Please enter a valid phone number.
Third Member

First NameLast Name
Birth Date

MonthDayYear
Email
Please include for electronic member card
Phone Number
Please enter a valid phone number.
Fourth Member

First NameLast Name
Birth Date

MonthDayYear
Email
Please include for electronic member card
Phone Number
Please enter a valid phone number.
Fifth Member

First NameLast Name
Birth Date

MonthDayYear
Email
Please include for electronic member card
Phone Number
Please enter a valid phone number.
Working Membership

Receive a 5% discount by contributing 6 volunteer hours per household member aged 16 and up. Volunteer at the Co-op or partnering community organizations. Enjoy an automatic 5% off in your first four months, and maintain the discount for the entire year by fulfilling your required work hours.
Do you plan to be a working member household? (Required)*
Your indication will help us plan for work shortages but will not be considered a binding decision.
Beneficiary (Required)

In the event of the Primary Member’s death, Equity will pass to the next Adult in the Household.If there are no other Adults in the Household, Equity will pass to your designated beneficiary.
Beneficiary Name (Required)*

First NameMiddle NameLast Name
Beneficiary Relationship (Required)*
Phone Number (Required)*
Please enter a valid phone number.
Beneficiary Address (Required)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Other Programs
Please send me information about these programs

Senior DiscountFood for All
Additional Comments or Questions for a Membership Team
Membership Equity Options (Required)
prevnext( X )
Basic Membership1 year Equity Payment
$30.00



Full Equity PaymentFull equity invests in the co-op and requires no additional annual equity payments
$400.00



Food For AllIf you would like to join the Food For All program, our low income discount program, we will follow up with the Food For All application to complete your enrollment.
$5.00



Total

$0.00
Should be Empty:

New Membership

Additional Household Members

Working Membership

Beneficiary (Required)

Other Programs