Form
Club Renegade Membership Application
Welcome to the Club! We're glad you're here!
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Member Agreement: I consume and/or have participated in the following:
*
Commercial Produce and vegetables
Pre-cut vegetables and fruits
Deli Meat
Prepared and/or ready-to-eat meals
Frozen Vegetables
Raw Oysters
Moringa Leaf Powder
Eat at restaurants
I understand these foods can carry E.Coli and Salmonella, LIsteria and other bacteria
I understand that raw (unpasteurized) milk may contain harmful bacteria and foodborne pathogens, including E. coli, Salmonella, and Listeria, which can cause serious illness. I also understand that other foods, including fresh produce, pre-cut fruits and vegetables, and improperly handled foods, may carry harmful bacteria.
I understand that, within 90 days of joining Club Renegade, I must complete either an in-person farm tour OR a virtual farm tour followed by a one-time, in-person meeting with Gretchen at my designated milk drop point..
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