New Member Form – Member Resources

2012 Lake County Community Co-op Registration

We encourage you to sign up for our newsletter, as we communicate valuable information regarding online ordering and other member related issues.

Thank you for your interest in becoming a member of Lake County Community Co-op. Lake County Community Co-op customers and producers are interested in local foods and products produced with sustainable practices that demonstrate good stewardship of the environment. Membership in the Lake County Community Co-op affords the member one vote, access to the Buying Club and contributes to the Friday Night Farmers' Market, the community gardens and the Lake County Community Co-op Presents... educational series. The annual membership dues are $24 per year. Payment increments of a minimum of $2 per month are afforded for those in need. For more information or assistance, please contact member_relations@lakeco-op.org

To become a member, please read the Terms of Service, and then complete the following information and click submit.

Address:

Address 2:

City/State/Zip:

County:

Do Not Send Postal Mail:

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 Lake County Community Co-op.

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:
	Regular Member A regular membership costs $24.00 per year.

Section 5: Additional Information

How you heard about Lake County Community Co-op:
Please give more detail:	What website, from whom, which publication/date, etc.?

YES! I‘m interested in volunteering to help Lake County Community Co-op.

I acknowledge that I have read and understand the Lake County Community Co-op Terms of Service statement.