2020 CSA Registration *Required IDPrimary Share MemberStatusReturning members have first priority. If you are a new member and you are registering before April 18, you will be prioritized after all returning members.Returning MemberNew MemberName* First Last Address* Street Address Address Line 2 ZIP Code Phone*Email* Enter Email Confirm Email Second Share Member?*NoYesSecond Share MemberFill this out only if you are splitting your share with another member. If you need to add additional people to your share for pick up, please fill out the information at the bottom of this form.Name* First Last Address Street Address Address Line 2 ZIP Code PhoneEmail VEGETABLE SHARESSHARE COSTS ARE FOR 25 PICK UPS WEEKLY: JUNE 13 THROUGH OCTOBER 31 (21 pickups) FOUR PICKUPS: NOVEMBER 7 AND 21 AND DECEMBER 5 AND 19 (4 pickups) We offer subsidies for those who need assistance. Subsidies are ONLY applicable to one (1) single vegetable share and not fruit or eggs. The admin fee is also waived. Subsidies are prioritized for returning members on a first-come first-served basis and are limited. If you need a subsidy, please check "Yes" below and read the options. There are no official requirements to prove that you need a subsidy. Any questions, please contact email@example.com Subsidized Shares The CSA is committed to ensuring that ALL can afford organic, super fresh, local vegetables regardless of income. A limited number of subsidies are available based on income level and household. Due to Covid-19 and job loss/reduction, we anticipate more people needing subsidies than ever. We have thought about how to structure this and the committee decided that we would not do a formal, laborious application process, nor a sliding scale structure. Subsidies are for people who need it due to their own personal situations. If you don't feel like you need a subsidy--even though you might qualify for one--please don't, but don't be afraid to take one because your life has changed! NOTE: This is largely experimental based on our membership base. But it's hard to know exactly how this will work given the unpredictability we face. It is subject to change. That said, please take a look at the chart below. Priority will be given to returning members until April 18. In deciding if you need a subsidy, take the subsidy IF: You anticipate your income in 2020 to be less than 60% of what it was in 2019 You do not think you can afford the regular installments over time (we are offering a 3 or 4-payment installment plan) You are unemployed/under-employed or anticipate being laid off in the next 6 months due to Covid-19. These industries in particular are anticipated to be affected for longer: restaurant/art/music/retail/gig work You or anyone in your household do NOT have the ability to work You are on Social Security or SSDI You are the sole earner in your household You do NOT qualify for unemployment due to Covid-19 (e.g. you are self-employed but still working/trying to work) You are a renter You have children under 18 or are caring for an older or disabled person Reasons to consider not taking a subsidy: You can afford the payment plan You are working or have the ability to get your job back during the season You have a support network who can help you You own a house You live with others who have the ability to work or are working If you can afford it, consider also taking less or more of a subsidy than your tier, especially if you fall between tiers. See the household and income tiers below for pricing. We based income levels on Area Median Income (AMI) which is set by New York City and US Housing and Urban Development. Your subsidy information will be kept confidential. If you still think you can't afford the CSA and need an extra subsidy, please contact us at firstname.lastname@example.org to work something out. Our goal is to serve everyone as much as possible so don't be afraid to reach out! If we also have funds remaining, we will reach out and ask you if you need more funding. Tier Level ---> HOUSEHOLD INCOME LEVEL TIER 1 (50% CSA discount) TIER 2 (35% CSA discount) TIER 3 (20% CSA discount) Number in Household 1 below $37,350 $37,352 - $52,290 $52,291 - $59,760 2 below $42,700 $42,702 - $59,780 $59,781 - $68,320 3 below $48,050 $48,051 - $67,270 $67,271 - $76,880 4 below $53,350 $53,351 - $74,690 $74,691 - $85,360 5 below $57,650 $57,651 - $80,710 $80,711 - $92,240 6 below $61,900 $61,901 - $86,660 $86,661 - $99,040 7 below $66,200 $66,201 - $92,680 $92,681 - $105,920 Subsidy Pricing?NoYesSubsidy Tier*No SubsidyTier 3: 20% discountTier 2: 35% discountTier 1: 50% discountSingle Vegetable Share* Price: $490.00 Do you want to order additional shares?NoYesAdditional Vegetable Shares*Use this ONLY if you are getting an additional share. Price: $490.00 Quantity: Total Veg QuantityHidden field for calculation and notification emailVeg. Share SubtotalHidden field for calculation and notification emailHELP SUBSIDIZE SHARES FOR OTHERSDue to Covid-19 and the shut down of many businesses, we anticipate more people who will need help accessing fresh, organic, local food. Help us serve more people by donating $15, $25 or $50! If you can help others out, please do! All donations will receive a CSA reusable bag.DONATE!Choose an amount$15$25$50Sorry, I cannot contribute at this timeFRUIT SHARESYou *must* order a vegetable share to have a fruit share. Fruit shares will follow the same schedule.Single Fruit ShareIf you want a double fruit share, order 2 shares. Price: $194.00 Quantity: Fruit Share QuantityHidden field for calculation and notification emailFruit Share SubtotalHidden field for calculation and notification emailEGGSYou *must* order a vegetable share to have an egg share. Full egg shares are for 29 dozen (1 dozen for 21 weeks and then 2 dozen per pickup for November 7 and 21, and December 5 and 19).Dozen Eggs Price: $131.00 Quantity: Half Dozen Eggs Price: $66.00 Quantity: Egg Share QuantityHidden field for calculation and notification emailEgg Share SubtotalHidden field for calculation and notification emailBAGSCSA Market Bag Price: $15.00 Quantity: Tote Bag SubtotalHidden field for calculation and notification emailGRAND TOTALPAY THIS AMOUNT $0.00 PAYMENTFull payment or a deposit of at LEAST 25% is due upon submission of your registration. But, you may then pay in installments. Payment Frequency --> THREE PAYMENTS FOUR PAYMENTS Due upon Registration 33% 25% Saturday, May 9 33% 25% Saturday, June 13 (first day of pick up) 33% 25% Saturday, July 11 X 25% How Are You Paying?*Full PaymentTwo (2) InstallmentsMethod*Electronically by Venmo (@plgcsa)Paper CheckCash Please make checks payable to PROSPECT LEFFERTS GARDENS CSA. Please put your Share Number as noted in your confirmation Email. Mail or drop off your form with deposit or full payment to: PLG CSA c/o Karen Oh 270 Sterling Street Brooklyn 11225 Make sure you write your name and “PLG CSA” on the envelope! If you are going to drop it off: address is between Rogers and Nostrand. Please put it through the mail slot. For electronic payments, PLG CSA uses Venmo. You can send payments directly to @PLGCSA or email@example.com. Please put your Share Number (found in your confirmation email) in your Venmo payment. Or, provide the email or your Venmo name so we can request payment from you.Account Email*Additional MembersList the names of ANY OTHER people who will need to be informed of CSA information such as start dates, changes in the CSA, share pick-up assistance or any critical information. Click on the plus sign to add more names. Check the box if you want to receive the newsletter from the farmer.First NameLast NameEmail Additional QuestionsDepending on the growing season, we may be able to offer additional one-off shares in 2021. Please let us know if you are interested.*Yes, I am interested in 2021 orderingNoIf you are able and willing to work extra shifts, please let us know*Because of Covid-19 and the unknown of what June will look like, we are prioritizing social distancing, health and safety in our distribution. This means we are overhauling our standard process of pick up and number of shifts required. We anticipate needing extra help for those who are high risk and cannot work on site. There are many of you who have stepped up with extra hands when needed and this season we are definitely going to need you! Please let us know if you are available for extra shifts.Yes! I can helpNoI cannot work due to being in a high-risk group or pregnantIf you prefer not to answer here, please feel free to email firstname.lastname@example.org with your situation. All personal information will be kept confidential. Yes AGREEMENT*Submission of this form and my deposit or full payment confirm my agreement to become a member in the Prospect Lefferts Gardens Community Supported Agriculture (PLG CSA) for the 2020 season. I will pick up my share at Maple Street School weekly for the duration of the season. If I am unable to pick up, I will arrange for someone else to pick up my share, or my share will be donated. I understand there are no refunds for missed shares or if I choose to leave the CSA for whatever reason. If I must leave the CSA, I will be responsible for selling or donating the remainder of my own share. I understand that I am obligated as a member of the PLG CSA to commit to working one (1) assigned distribution shift and to join the PLG CSA listservs. Accordingly, I understand that if I fail to fulfill my full work commitment, that I will not be permitted to rejoin the CSA for one season. I understand that CSA involves sharing the rewards and risks (e.g. crop failure, poor weather, early winter, pandemics, etc.) with our farmer. I accept that there may be things that are out of the control of the farmer or PLG CSA that may put my share at risk and that, while the farmer and PLG CSA will do everything within their power to ensure that shares are distributed and commitments are kept, events may lead to shares being delayed or cancelled without reimbursement. I understand that this is part of the shared risk of a CSA. I understand that my share may vary from week to week and that there is no guarantee on the exact amount or contents of my share. The shares will vary in weight and size depending on the time of season. I agree not to hold PLG CSA or anyone acting on its behalf, including any agents, officers, volunteers, or employees, responsible for any and all damages and/or costs resulting from injuries sustained as a result of any carelessness or negligence by any person while engaged in any event or activity, including but not limited to the weekly distribution, farm visits, or any event or activity that is sponsored, held, or coordinated by PLG CSA. I further agree to indemnify and hold harmless PLG CSA and/or the Maple Street School against all claims, including, without limitation, third party claims, demands, recoveries and deficiencies suffered, incurred or sustained by PLG CSA and/or the Maple Street School which arise out of my negligence, gross negligence, and/or willful misconduct while engaged in any event or activity, including but not limited to the weekly distribution, farm visits, or any event or activity that is sponsored, held, or coordinated by PLG CSA. By participating in PLG CSA, I’m bringing healthy local organic food to my neighborhood, supporting local and alternative agriculture, building community and making Prospect Lefferts Gardens a great place to live! I have read this agreement and agree to its terms. I Agree CommentsThis field is for validation purposes and should be left unchanged. Theme: Illdy.