Nebraska Food Cooperative

2010 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 Terms of Service, 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:

Business Name:

Section 2: Contact Information

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:

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. NOTE: If you register as a visitor you will not be able to sell through the co-op as a producer until you upgrade to one of the other membership types.

Section 5: Additional Information

How you heard about Nebraska Food Cooperative:
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 Terms of Service and Member Information Statement.

I am interested in becoming a producer member for Nebraska Food Cooperative.

	Our Mission: To foster a local food community and promote a culture of stewardship by cultivating farmer-consumer relationships, promoting the enjoyment of healthful food, increasing food security through diversity, and enhancing overall rural sustainability.

Address:

Address 2:

City/State/Zip:

County:

Do Not Send Postal Mail: