Join our thriving community Crow Wing Food Co-op Membership Application Your Name*Others in my household*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone* I agree to purchase one life-time family membership, paying dues of $150.00 to be come a fully vested member-owner of Crow Wing Food Co-op. I am paying my dues in full to be a fully vested member-owner of Crow Wing Food Co-op Gofundme I donated ______($ amount) via GoFundme to launch a new membership Gofundme amountFull $150 in membership I am paying ______ ($ amount) in dues today and will make incremental payments until I am a fully vested member, recognizing that I will not earn membership dividends until I have paid the full $150.00 in membership dues. Full $150 membershipPrevious dues totaling $60 or $80 I am already a member-owner and I would like to bring my legacy membership (previous dues totaling $60.00 or $80.00) to the new fully vested member level of $150.00 by paying an additional ________ on my membership previous dues totaling $60-80Membership dues were increased from $80.00 to $150.00 by a member vote in December2019. Patronage dividends will be allocated back to member-owners each year the Co-op is profitable. Patronage dividends are given based on a proportion of profit that the business makes, calculated based on how much the member-owner has utilized Co-op services.Member Signature*Date* Date Format: MM slash DD slash YYYY Member No: (if known/applicable)(assigned by CWFC staff)Dues Payment Method Check in the mail Check or credit card at store Call Me for credit card # New Member Survey