Wisconsin Apple Growers Association 211 Canal Rd., Waterloo, WI 53594 Date: MEMBERSHIP FORM
Orchard/Company Name Name Address City State Zip County Phone Fax E-Mail Website Facebook page Orchard Address
_____ New Membership _____ Renewal Membership
□ Grower Membership - Base $60 annually plus $2.50 per bearing acre Designated Research Funds ______Number of Bearing Acres x $2.50 = ______plus $60 = $______□ Associate Membership - $100 (For apple-related businesses) $ ______OPTIONS: Inclusion on WAGA Orchard Map - $65 $ ______(publishing, printing and distribution costs) Additional Donation for Apple Promotion $ ______
TOTAL ENCLOSED $______Make check payable to: Wisconsin Apple Growers Association 211 Canal Rd., Waterloo, WI 53594 Phone: (920) 478-4277 Fax: (920) 478-9586
Charge to my (circle one) MasterCard Visa Discover
Cardholder ______
Card Number ______Exp. Date ______
Signature ______Security Code (3 digit code on back of card)______
Member Information Every member of the Wisconsin Apple Growers Association can be listed on the WAGA website. Do NOT list my orchard information on the WAGA website or promotional information. Please list your specialties and/or attraction(s) on the lines below.
List special features and attractions, directions, hours of operation, pick your own, cider, caramel apples, school tours, other produce, crafts, gift shop, etc. Thank You For Being a Member of the Wisconsin Apple Growers. Wisconsin Apple Growers Association 211 Canal Rd., Waterloo, WI 53594
Please Check: □ Pick Your Own □ Pre-Picked □ Organic □ Apple Cider □ Caramel Apples, □ Bakery □ Orchard Store □ Fall Produce □ Wholesale
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□ Fireside □ Missouri Pippin □ Rubinstar □ Fortune □ Mollies Delicious □ Ruby Mac □ Freedom □ Monroe □ Sansa
□ Frostbite □ Mother □ Scarlet □ Fuji □ Mutsu (Crispin) □ Scarlet Surprise □ Fulford □ Early New Yorker □ Secor □ Gala □ Newtown Pippin □ Senshu
We’re trying to gather information on “cider” apple varieties on Wisconsin Orchards. Please list below the varieties you have and how many trees. Please add additional pages if necessary. Thank you.
Cider Apple Varieties Number of Trees Cider Apple Varieties Number of Trees
Thank You For Being a Member of the Wisconsin Apple Growers.