Name     
Telephone Number (Home) 
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Street Address:
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Email Address

I wish to become a Wellspring member at $25 a year or a Tree Hugger @ $50, an Associate @ $100, a Trail Blazer @ $250, an Ecology Partner @ $500 or an Earth Steward  @ $1,000(see Membership page for descriptions).

I want to buy a garden share for the coming season which runs from the 1sr week of June to the 2nd week of November, 24 weeks of fresh, organic produce..
       Single share @ $550   Double share @ $995 Half Share @ $300 for 12 weeks Community Share @ $530 plus helping 4 hours on the farm one time during the season.

Discounts for full shares who pick up closer to the farm:
    Grafton, deduct  $50, West Bend, deduct $25, at the farm deduct $100.

Payment Options-- Please Check One:
Checks made payable to Wellspring and mail to:   
       4382 Hickory Rd.  West Bend WI 53090  
       (Please print the confirmation form and include with payment)
VISA and Master Card accepted with an additional 3% bank charge.