New member form

Thank you for signing up as a new member of Quabbin Harvest! We're very happy to have you join us as a member-owner.

Use this membership form if you are paying the $120 lifetime membership fee all at once. You can make an electronic payment at our secure online store.

You may also pay in four quarterly installments of $30. Please come in to the store to fill out a hard copy of this form and make your first payment, or call us at 978-544-6784 and pay over the phone with a credit card if you wish.

First name*

Last name*

Email address*

Telephone (primary)*

Telephone (other)

Postal address*

Town*

State*

Zip code*

Can you volunteer?

Yes! Call me - I can help. Not now - maybe later. Don't call me about volunteering.

How did you hear about us?

1. Member equity shares can be paid in one $120 lump sum or four quarterly payments of $30 over a year.
2. Members must abide by the rules and regulations of the North Quabbin Community Co-op (NQCC), dba Quabbin Harvest. Our bylaws are available in hard copy in the store and here on our website.
3. Each household is issued a member-owner ID number. Each household is entitled to one vote at the Annual Meeting in addition to other member benefits determined by the board of directors. 4. I understand that this is a household membership and is valid for all members of my household listed here:

List family member names

5. Membership with NQCC is an at will commitment. I agree to hold harmless and indemnify from loss or damages all volunteers and staff of the NQCC.

6. I understand that my equity share investment is unsecured and redemption requests cannot be guaranteed

Your typed name here will serve as your signature.*

Date*

Your Friday Color*

Please review what you entered before you click the Submit button, and click it ONLY ONCE.

New member form

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