Type of Application New membership Renew membership Which county Farm Bureau will you join or renew your membership? * Required Annual membership dues are determined by each county. Addison: $75 Orange: $70 Bennington: $65 Orleans: $70 Caledonia: $67 Rutland: $65 Chittendon: $70 Washington: $70 Essex: $65 Windham: $80 Franklin: $65 Windsor: $70 Grand Isle: $65 All County Member: $525 Lamoille: $70 Member Name First Name * Required Last Name * Required Co-Member Name First Name Last Name Contact Information Address Line 1 * Required Address Line 2 City * Required State * Required Vermont Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Required Primary Phone * Required Phone Type Home Cell Work N/A Secondary Phone Phone Type Home Cell Work N/A Email Email me the legislative update "Under the Golden Dome." Who first introduced you to Vermont Farm Bureau? No Response VTFB.org Fences Magazine VTFB Member (please enter her/ his name below) If an insurance agency introduced you to VTFB, check the agency. Blodgett D Blondin S Blosser G Campbell P Chalmers D Davis H Fewer J Frazer L Hungerford T Levesque R Miller D Mullen J NSS-Amarillo NSS-Des Moines NSS-Portland NSS-Lynchburg NSS-San Antonio Perkins W Steere D This optional survey is intended for farmers and foresters. Farm / Company Name Number of Acres Kind of Farm Major Commodities Bedding plants Forestry Llamas/alpacas Beef cattle Fruit Maple syrup Bees Goats Poultry Christmas trees Greenhouse Rabbits Dairy farmer Hogs Sheep Field crops Horses Veal Fish farm Livestock Vegetables Other commodities? Do you have children under 21 living at home? Yes No N/A If yes, are they involved in agriculture? Yes No N/A Billing Address for Credit Card Check if the billing address is the same as the mailing address. County Dues Ag Education $25 suggested donation Legal Fund $25 suggested donation Gold Card $135 suggested donation Total First Name * Required Last Name * Required Address * Required City * Required State * Required Zip Code * Required 117 West Main Street • Richmond, Vermont 05477 • 802-434-5646