Member Services--Virginia Farm Bureau

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Membership Application

Your membership entitles you to a host of benefits. Please complete the information below and become a Farm Bureau member.

To pay by credit card, please complete the membership form on our secure Web site.

If you would like to print and mail a copy of your membership application to your county Farm Bureau, you may access one here.

* Required fields

*Name:

Nickname:

*Date of Birth:

*County:

*Address: (mailing)

*City:

*State:

*Zip Code:

Address: (physical)

City:

State:

Zip Code:

*Home Phone:

Office Phone:

Cell Phone:

Fax:

*E-mail Address:

This Family Membership should be classified as:	Producer--a producer of agricultural products who sells such products on a commercial basis as a source of income and/or owner of farm land. Associate--any other person, firm or organization directly interested in the advancement of agriculture.

Acres owned:

Acres farmed:

Acres rented from others:

Acres rented to others:

Please check all that apply:	Certified Organic Operation Pick-your-own Operation Agri-Tourism Operation

If you farm, please indicate which product(s) you produce for cash sales:

Apples
Aquaculture
Beef Cattle
Broilers
Cherries
Cotton
Dairy
Emus/Ostriches
Feed Grains
Flowers
Fur Animals
Game Birds
Goats

Grapes
Hay/Straw
Horses
Layers
Llamas/Alpacas
Mushrooms
Nursery Stock
Peaches
Peanuts
Potato, Irish
Potato, Sweet
Sheep
Small Fruits

Swine
Timber
Tobacco-Flu Cured
Tobacco-Burley
Tobacco-Fire Cured
Tobacco-Sun Cured
Turf Grasses
Turkeys
Vegetables
Wheat
Other
Not Actively Farming

Family Relationships within the household

Name of family member:

Date of Birth:

Relationship to member:

Home Phone:

Cell Phone:

Office Phone:

Fax:

E-mail Address:

Name of family member:

Date of Birth:

Relationship to member:

Home Phone:

Cell Phone:

Office Phone:

Fax:

E-mail Address:

Name of family member:

Date of Birth:

Relationship to member:

Home Phone:

Cell Phone:

Office Phone:

Fax:

E-mail Address:

Have you visited our other Website, SaveOurFood.org?	Yes--I clicked the link on SaveOurFood.org and was directed to this page. Yes--But, I did not come directly from SaveOurFood.org. No--I have never visited SaveOurFood.org.

If you were referred by a VFB employee, please enter their name.

	Once we receive your application, we will send you a bill for $40. Membership will be activated upon receipt of payment. Thank you. Please note: Membership dues are non-refundable.

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