FNA Membership Application

To help us serve you better, please provide as much of the information requested below as possible.

Farmers of North America Membership Application

Company Name (If applicable):
GST or Business #:
First Name:
Last Name:
Secondary Contact First Name:
Secondary Contact Last Name:
Address:
City/Town:
Province:
Postal Code:
Telephone:
Facsimile:
Email:
Cell Phone:
Alternative Number:
Preferred Type of Monthly Contact (check applicable box)

Email

Fax

Mail

Section 2 - Farm Location

Qtr.
Sec.
Twp.
Rge.
Merid.
RM/County:
Acres:
Directions to Farm (Delivery Point). Indicate Starting Point (nearest town):

Section 3 - Membership Type

Choose a membership length

1 Yr Membership Fee - $625.00*
3 Yr Membership Fee - $1675.00* Save $210!
5 Yr Membership Fee - $2625.00* Save $525!
* Applicable sales taxes will be calculated upon checkout.
$625.00

$1675.00

$2625.00
Comments:
Representative:
Referred by (FNA member name):
Preferred Language:

English

French

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