Please complete the following section. Then print this form and mail
it to the address at the bottom with your remittance. It is the
policy of New York Farm Bureau that membership dues are not refundable.
Name
Title or Occupation
Organization or Farm Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work or Farm Phone
Home Phone
Fax
E-mail
Web Page URL
Please tell us a little about your farm or
organization. In the spaces provided below, please list the major
commodities produced by your farm, your farm interests or list
the type of business.
Commodity or Business Emphasis
If you want to charge your membership to a credit card, please
provide the following information:
BILLING
Credit Card
Cardholder Name
As it Appears on your card
Card Number
Expiration Date
Choose one of the following options: (Upon
membership application acceptance, the appropriate County Farm
Bureau determines the membership category of new and renewing
members.)
Regular (farmer)
Associate
Renewal
Junior
Ages 16 - 23 years
If applying for Junior membership, please enter birth date in the
space provided below.
Choose one of the following counties for your membership:
At this time, New York Farm Bureau is not able to accept membership
applications through this web site. Once you have completed this
form, use your computer's print option to print this page. Then sign and
date. Include a check for appropriate dues amount for the county you
selected ($20 for Junior Membership) or complete the credit card
information section of this form, then send to:
New York Farm Bureau
159 Wolf Road, PO Box 5330
Albany, NY 12205-0330
New York Farm Bureau, Inc.
159 Wolf Road, P.O. Box 5330, Albany, NY 12205-0330
Phone: (518) 436-8495 Fax: (518) 431-5656
Last Updated
October 05, 2007
Send questions or comments to: NY Farm Bureau
