2008 CSA Registration Form

Name:

Address:

City:

Phone:

Email:

I will pick up my box at:

Place Day of the Week Time

Ø Good Samaritan Hospital - Corvallis Friday 1pm-4:30pm

Ø Good Samaritan Hospital - Albany Tuesday 2pm-4pm

Ø City of Corvallis Friday 11:45am-4:30pm

Ø Heavenly Harvest Farm Tue or Friday 1pm-7pm

Ø Corvallis Market Wednesday 8am-1pm

Ø Beaverton Market Wednesday 3pm-7pm

ØEcotrust Market Thursday 6pm-8pm

ØEastbank Market Thursday 6pm-8pm

Ø Corvallis Market Saturday 9am-1pm

Ø Newport Market Saturday 9am-1pm

Ø Beaverton Market Saturday 9am-2pm

Payment: (please include payment with registration form)

Full Box:

ØFull Payment: $426 if before May 20^th. $456 after May 20^th.

ØPayment Plan: $213 By May 20th. Second Payment of $213 by July 1^st.

¾ Box:

ØFull Payment: $330 if before May 20^th. $360 after May 20^th.

ØPayment Plan: $165 By May 20^th. $165 by July 1^st.

Add on:

ØLarge Dozen Eggs weekly: Full season payment: $66 due with first payment.

ØPayment Plan: If using payment plan, $33 dollars due with each check.

Please return payment and completed form to

Heavenly Harvest CSA

5757 NE Hwy 20

Corvallis , OR 97330

If you have any questions please call 541-753-5795