2021 CSA Registration *Required IDPrimary Share MemberStatusReturning MemberNew MemberName* First Last Address* Street Address Address Line 2 ZIP Code Phone*Email that you check often* Enter Email Confirm Email Second MemberFill this out if you have another person who will be picking up, will work a shift or would like to know about PLG CSA news. 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 PhoneEmail DISCOUNTSWe offer a limited number of discounts for those who need assistance. Discounts are prioritized for returning members on a first-come first-served basis and are based on single shares of vegetables, fruit AND/OR eggs. (Additional shares will be at full price.) If you need help paying for your share please email us at firstname.lastname@example.org or call us at 646-397-4568 and leave a message.VEGETABLE SHARESSHARE COSTS ARE FOR 24 PICK UPS WEEKLY: JUNE 12 THROUGH OCTOBER 30 (21 pickups) THREE (3) PICKUPS: NOVEMBER 20, DECEMBER 4 AND 18Single Vegetable Share* Price: $500.00 Do you want to order additional shares?NoYesAdditional Vegetable SharesUse this ONLY if you are getting an additional share. Price: $500.00 Quantity: Total Veg QuantityHidden field for calculation and notification emailVeg Share SubtotalHidden field for calculation and notification emailFRUIT SHARESYou *must* order a vegetable share to have a fruit share. Fruit shares will run for 21 WEEKS from June 12 to October 30.Product Name Price: $185.00 Quantity: Because you are getting a discount, if you want to order additional Fruit shares, you must add them here.NoYesAdditional Fruit Shares Price: $185.00 Quantity: Total 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 28 dozen: 1 dozen for the first 20 weeks, and then 2 dozen (double) per pickup for October 30, November 20, and December 4 and 18. Half egg shares are for 14 dozen: 1/2 dozen for the first 20 weeks and then 1 dozen (double) per pickup for October 30, November 20, and December 4 and 18.Dozen Eggs Price: $137.00 Quantity: Half Dozen Eggs Price: $69.00 Quantity: Because you are getting a discount, if you want to order additional Egg shares, you MUST add them here.NoYesAdditional Dozen Eggs Price: $137.00 Quantity: Additional Half Dozen Eggs Price: $69.00 Quantity: Total Egg Share QuantityHidden field for calculation and notification emailEgg Share SubtotalHidden field for calculation and notification emailDONATE!Help others afford the CSA!The effects of the Covid-19 pandemic are still affecting many people and will continue to do so in 2021. This year, we are offering assistance for vegetable as well as fruit and egg shares. Please help others afford the CSA this year! Your support is even more critical to provide access for all to 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.Select a donation amount$15$25$35$50$100Or, enter in your own donation amount here: BAGSCSA Market Bag Price: $15.00 Quantity: Tote Bag SubtotalHidden field for calculation and notification emailShare Total (with any discounts applied)Total $0.00 PAYMENTFull payment or a deposit of at LEAST 20% is due upon submission of your registration. Suggested Payment Frequency--> TWO PAYMENTS THREE PAYMENTS Due upon Registration 50% 20% Saturday, May 19 (or before) remaining balance (or on June 12) half of remaining balance Saturday, June 12 (first day of pick up) n/a (or remaining balance) remaining balance How Are You Paying?*Full PaymentTwo (2) InstallmentsThree (3) InstallmentsMethod*Venmo (@plgcsa)Zelle (email@example.com)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. Venmo payments: Send payments to @plgcsa or or firstname.lastname@example.org. The last 4 digits of the phone number associated with our account is 4568. Zelle payments: Send payments to email@example.com. Please put your Share Name and Number (found in your confirmation email) in your payment so we can match payments and follow up.Venmo Account Name*Zelle Account Email*Additional MembersList the names of ANY OTHER people who need to be in the Google Group listserv. The list is used to communicate important CSA information such as start dates, changes in the CSA, special orders (like coffee, syrup, honey, etc.) share pick-up assistance or any critical information. Click on the plus sign to add more names. First NameLast NameEmail 2021 AgreementAGREEMENT*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 2021 season. I agree that each distribution ends at noon sharp, and if my share has not yet been picked up by noon sharp then it will be automatically donated. I will pick up my share at Trailblazers (397 Rogers Avenue, Brooklyn, NY 11225) 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 communicating this with PLG CSA and assisting in selling the remaining weeks of my share, or I will donate it. 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 Trailblazers against all claims, including, without limitation, third party claims, demands, recoveries and deficiencies suffered, incurred or sustained by PLG CSA and/or the Trailblazers 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 Additional QuestionsEmergency CSA ShiftsIf you are able and willing to work extra shifts, please let us know! Because of Covid-19, we anticipate needing extra help for those who are high risk and cannot work on site. As well, we sometimes need last minute help due to people not showing up. 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 check here if you are available to help out on short notice.Yes! I can helpNoOpting Out of Working ShiftsIf you cannot work because you are high-risk for Covid-19, disabled, pregnant, care for someone who is high risk, or are uncomfortable working in small groups, please check here. If 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. I would prefer to opt-out of my shift Off-Season Food BoxesDepending on how things run this year, we are looking into one-off food boxes during the off season (January - June 2022). Please check here if you are interested.Yes, I am interested in 2022 orderingNoNameThis field is for validation purposes and should be left unchanged. Theme: Illdy.