ALABAMA WINEMAKERS AND GRAPE GROWERS ASSOCIATION
MEMBERSHIP APPLICATION FORM
Date
*
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Month
-
Day
Year
Date
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
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Area Code
Phone Number
Vineyard Name (if applicable)
County, State & Zip
Facebook profile url (i.e. https://www.facebook.com/kimberly.ellis.miller) :
*
Interest
*
General Interest/wine lover
Winery (current or future)
Amateur Winemaker
Commercial Winemaker
Grape or Fruit Grower
Extension Service
Library
University
Dealer (specify) ___________
Other (specify) ___________
Number of total vines grown
Wine Grape Vines
Table Grape Vines
Other fruit/berries
List variety of grapes or other fruit grown (i.e., Cynthiana, etc.)
Are you willing to sell to members who need fruit?
Membership Directory Information
*
Include All Info
Omit Phone
Omit Address
Omit Email Address
Omit All
Email
example@example.com
*
Submit
Should be Empty: