Member Name            ___________________________________ Date  _________, 20____
(name or farm)

Alternate Name           ___________________________________
(farm or name)

Civic Street Address        ___________________________________

Civic Town/Community   _____________________  Prov ____  Postal Code __________
 

Phone Numbers

Home          (          )  ________ - ____________

Office          (          )  ________ - ____________

Fax              (          )  ________ - ____________

Cell              (          )  ________ - ____________

Email            ________________________ @ ______________________________
 
 

Annual Membership  (February 1 to January 31)

__  Regular (producer)

__  Associate
 
 

Apple Farmers' Association of Nova Scotia                                            Office Use:
2380 Harmony Road                                                     RD    AM    CN    DT    RN    DD   RS   MN
Aylesford  NS    B0P 1C0

Preferred method of communication (check one):
mail  _____     fax  _____     Email _____