New Member Form

New Member Form

Fill out the form carefully for registration
Applicant Type*
Farming Involvement*

Applicant has gross farm income of $2,500/yr or more.Is applicant a full-time or part-time employee, agent, or independent contractor of IAA or a County Farm Bureau or is member a full-time employee, agent, or independent contractor of COUNTRY?Member Choice: Applicant is a full-time on farm employee and wants to be classified as a Regular Member (MM)Member Choice: Applicant is employed in an agriculture-related occupation and wants to be classified as a Professional Member (PM).This is an additional membership for spouse.
Applicant Name*

First NameMiddle NameLast NameSuffix
Birth Date*

MonthDayYear
Occupation/Employer
E-mail*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Township you reside in
Spouse Information

First NameMiddle NameLast NameSuffix
Birth Date

MonthDayYear
E-mail
example@example.com
Membership Agreement

By filling out this Washington County Farm Bureau membership application, you are providing consent for the Washington County Farm Bureau to contact you in regard to membership payment. Based off the information provided, a dues amount will be quoted and required to be eligible for benefits provided by Washington County Farm Bureau.
Signature*

Clear
Type Signature Name*
Questions/Comments
Should be Empty:

Membership Agreement