2018-2019 Membership Form Contact us if you need to arrange a payment plan or you are interested in one of our limited number of work share memberships. Both options must be arranged in advance before filling out this form. Your Household* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Email* Enter Email Confirm Email Phone*Sharing your boxAre you sharing your box with someone else? Please list their information. First Last Address Street Address City State / Province / Region ZIP / Postal Code Email DeliveryDeliveries will be Thursdays or Saturdays depending on the drop site. Is your house or workplace a Foxtail drop site? Yes, my house or workplace is a drop site No, my house or workplace is not a drop site Which dropsite/day will you be picking up from?*Forest Lake, Hwy 97 and Fenway Ave., 4884 206th Drive Ct. N., SaturdayFredric, Clam Falls Dr and Hwy 35, 1125 Clam Falls Dr., SaturdayLake Elmo, Manning Ave. and Hwy 94, Manning Ave. and Hwy 94, ThursdayLindstrom , Hwy 8 near Library, 12605 Bronson Ave., SaturdayMpls, Harriet and 42nd, 4200 Harriet, SaturdayMpls, Ready Meats, 3550 Johnson St. NE, ThursdayMpls, Diamond Lk. Rd. and Hwy 53W, 5339 Pleasant Ave. S., SaturdayMpls, 4225 23rd Ave. S., SaturdayMpls, 34th St. and 16th Ave., 3433 16th Ave. S., SaturdayMpls, Nature Conservancy, West River Pkwy and 11th (employees) , 1101 West River Pkwy Ste 200, ThursdayMpls, Plymouth and Washburn, 1235 Washburn Ave. N, ThursdayMpls, Bryant and 24th St., 2439 Bryant Ave. S., ThursdayMpls, Mother Earth Gardens, 3738 42nd Ave. S., ThursdayOsceola, Foxtail Farm, 124 - 280th Street, SaturdayOsceola, Foxtail Farm, 124 - 280th Street, ThursdayRoseville, County Cycles, Lexington and Co. C., 2700 Lexington Ave., SaturdayRichfield, Lakewinds Coop, 6420 Lyndale Ave S., ThursdayShafer, near Hwys 97 and 243, 25408 Red Wing Ave., ThursdaysSt. Anthony, Silver Lake Rd & Hilldale, 3109 Hilldale, N.E., SaturdaySt. Louis Park, Xenwood and Minnetonka Blvd., 2939 Xenwood Ave. S., ThursdaySt. Paul, Hague and Wheeler, 1764 Hague Ave., SaturdaySt. Paul, Scheffer and Pascal, 1287 Scheffer Ave., SaturdaySt. Paul, Breda and Hamline, 1373 Breda, SaturdaySt. Paul, 1729 Englewood Ave, SaturdaySt. Paul, Simpson and Hoyt, 1512 Simpson St., SaturdaySt. Paul, Nebraska and Victoria, 999 Nebraska Ave. W., SaturdaySt. Paul, Maryknoll and Frost, 2009 Maryknoll, SaturdaySt. Paul, Hampden Park Coop, 928 Raymond Ave., ThursdaySt. Paul, Pinehurst and Kenneth, 1947 Pinehurst Ave., ThursdaySt. Paul, Unity Unitarian Church, Portland and Grotto, 733 Portland, ThursdaySt. Paul, Bethesda Hospital, Capitol and Univ Ave. (employees), 559 Capitol Blvd., ThursdaySt. Paul, MPCA, 520 Lafayette (employees), ThursdayStillwater, River Market, 221 Main St. N. #1, ThursdayTaylors Falls, Coffee Talk, Hwy 95 next to Library, 479 Bench Street, SaturdayWhite Bear Lake, Sassafras Health Foods, Hwy 61 and 3rd St., 2186 3rd Street #110, SaturdayName of resident or company hosting the deliveryAddress Street Address City State / Province / Region ZIP / Postal Code For drop site hosts: What are the cross streets?Building descriptionWhere should we leave the boxes?DROP SITES MUST HAVE A PORCH OR PROTECTED AREA FOR BOXES!Membership Options*Winter ShareWinter Share WITH Bread SharePayment Method*Winter Share Only - Check or Cash - $670Winter Share Only - Credit Card - $690 (includes credit card fees)Winter Share WITH Bread Share - Check or Cash - $710Winter Share WITH Bread Share - Credit Card - $731 (includes credit card fees)Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.