WFMVGA Member Registration

WFMVGA Member Registration
Date

MonthDayYear
Date
Conference Discount
Contact Name

First NameLast Name
Business Name
Please put N/A if not applicable.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Farm Location (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number

Area CodePhone Number
Hotline/Other:

Area CodePhone Number
County
Email
example@example.com
Website
Facebook
Twitter
Check here if you DON’T want to be listed on WFMVGA website or promotional materials.
I sell (Check all that apply):

AsparagusApples/tree fruitsBedding plants/flowersBerriesBroccoli/Cauliflower/CabbageCookingGreens/Salad GreensGarlicGrapesHerbsHoney/SyrupMelonsOnionsPeasPeppers/eggplantPotatoesPumpkins/gourdsRhubarbRoot crops (beets, turnips, etc)Sweet CornSweet potatoesSummer Squash/CucumbersTomatoesWinter SquashOther
Membership Types

Grower Member: $120Associate Member: $120 - Industry related company membershipsFriend Members: $40 - Retired members; University & Extension personnel; Not-for-Profit Ag. Organizations; TradePublications; (places you on the mailing list and Fresh Magazine)
How did you hear about us?

Rack CardPost CardWebsiteSocial MediaWord of MouthOther
Total Fees Due
Discount Applied

A $20.00 Conference Show Discount has been applied.
Payment Method

Mail PaymentPay Online
Checks Payable to:
WFMVGA

Mail to:

WFMVGA
1255 S Westhaven Dr,
Oshkosh, WI 54904

Email:
info@wiberriesandveggies.com

Phone:
608-692-2748
Credit Card Calculation
Director's Email

Should be Empty:

WFMVGA Member Registration

Discount Applied

Credit Card