2012 Nebraska Food Cooperative Registration

Thank you for your interest in becoming a member of Nebraska Food Cooperative. Nebraska Food Cooperative customers and producers are interested in local foods and products produced with sustainable practices that demonstrate good stewardship of the environment. To become a member, please read the Member Information Statement (beginning on page 4), and then complete the following information and click submit.

If you are already a member, please sign in here. Otherwise fill out the form below to become a member.

Section 1: General Information
First Name: Last Name: First Name 2: Last Name 2:
Invoice Name:   NOTE: Invoice Name can be edited. It will be used to route your order and should be easily tracable to you. It could be the common form of your name like "Alf Jones" instead of "Alfred Jones". If preferred, your Business Name may be used for the Invoice Name. Business Name:   I am interested in becoming a producer member for Nebraska Food Cooperative.
Section 2: Contact Information
Address: Address 2: City/State/Zip:   County: Do Not Send Postal Mail:
Work Address: Work Address 2: City/State/Zip:
Home Phone: Work Phone: Mobile Phone: FAX: Toll Free:
Email Address: Email Address 2: Home Page: http://
Section 3: Access Credentials
Username: Enter the word Human validation text Password: Confirm:
Section 4: Membership Type
Membership Type: Choose One Voting Member Non-voting Member Visitor Free Trial Voting Member $100.00 for one share of common stock — plus $20.00 annual fee thereafter, waived the first year. Non-voting Member $40.00 annual non-voting member fee. Visitor No membership fee but $6.00 visitor fee will be added to each order. Visitors are not be permitted to sell through NFC until upgrading to an annually-paid membership option. Free Trial Order once for free and choose a regular membership option with your second order. NOTE: Your first order will begin when you open your shopping basket. Free trial memberships are not permitted to sell through NFC.
Section 5: Additional Information
How you heard about Nebraska Food Cooperative: Choose One Newspaper Article Magazine Online Friend or Family Flyer or Booth Sign or Billboard Radio Program Other Please give more detail: What website, from whom, which publication/date, etc.?
YES! I‘m interested in volunteering to help Nebraska Food Cooperative.
I acknowledge that I have read and understand the Nebraska Food Cooperative Member Information Statement.