Membership Application

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: $80 Orange: $75
Bennington: $70 Orleans: $75
Caledonia: $75 Rutland: $70
Chittenden: $75 Washington: $75
Essex: $70 Windham: $80
Franklin: $70 Windsor: $75
Grand Isle: $70 All County Member: $525
Lamoille: $75
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
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?
VTFB.org
Vermont Fences Magazine
Suburban Propane, Fuel Oil, and On and Off Road Diesel Discounts
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
Jabaut J Levesque R Miller D
Mullen J NSS-Amarillo NSS-Des Moines
NSS-Lynchburg NSS-Portland 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
Dairy Fruit Horses
Maple Organic Vegetables
Other commodities?
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