First Name *

Last Name *

Email *

Phone *

Pickup Locations (SELECT ONE) *

West Midtown – West End Park (Thurs 4pm-6pm)

Southeast Atlanta – Grant Park (Sat 12pm-2pm)

Dennisur Farm – Powder Springs (Fri 12pm-2pm or 4:30pm- 6:30pm)

Do you or anyone in your household have any food allergies?

I understand this CSA membership is a 5 or 10 week commitment (depending on my shares). *

YES

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