Cheque Payment Only Membership Form

Create Username *
Username
Create Password *
Password
Membership Level
Cheque Payment Pending
First Name *
First Name
Last Name *
Last Name
Mailing Address *
Mailing Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Primary Phone
Primary Phone
Email *
Email
Company Name
Company Name
Please choose which membership you would like: *
Individual Membership ($55)
Farm Corporation ($55)
Agriculture Business ($275)
Agriculture Related Non-Government Org ($275)
Agriculture Related Government Org ($275)
Other (as approved by AFIN Board Members) ($55)
Designated Voter Names
If application is for a Ag business or other organization, please provide the following for EACH of the designated Voters: NAME / PHONE / EMAIL
According to the Personal Information Protection Act (PIPA), no membership information collected for use by AFIN will be sold or re-distributed at any time. Do you agree to allow AFIN to send you quarterly emails or updates when necessary? *
Yes