2013 High Plains Food Cooperative Registration

Thank you for your interest in becoming a member of High Plains Food Cooperative. High Plains 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:
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 High Plains 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 Voting Member $100.00 for one share of common stock Non-voting Member $40.00 annual non-voting member fee.
Section 5: Additional Information
How you heard about High Plains Food Cooperative: Choose One Newspaper article Magazine Online Friend or Family Flyer or Booth Other Please give more detail: What website, from whom, which publication/date, etc.?
YES! I‘m interested in volunteering to help High Plains Food Cooperative.
I acknowledge that I have read and understand the High Plains Food Cooperative Terms of Service statement.