Membership | Maine Farm Bureau

Contact Info
Membership Number*
Name*
First Name Middle Name Last Name
This field is hidden when viewing the form
Birthdate
MM slash DD slash YYYY
Spouse's First Name
Spouse's Last Name
This field is hidden when viewing the form
Spouse's Birthdate
MM slash DD slash YYYY
Email*
Home Phone*
Work Phone
Cell Phone
Address*
Street Address Address Line 2 City State Zip Code
County*
Town/Township(s) you are located in
Farm Info
Farm Name
Size of Farm Operation

Commodities Produced

Farming Regular 150
Price:
Farming family (2 votes) 200
Price:
Farming Gold Club 250
Price:
Farming Platinum 500
Price:
Young Farmer 18 - 35 - 150
Price:
Farming Support Associate - 25
Price:
Farming Support Ag Organization - 300
Price:
Farming Support Business - 300
Price:
Your annual membership is only:
$0.00
This field is hidden when viewing the form
Payment Method*
- Credit Card
- eCheck
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
eCheck
Address*
Street Address Address Line 2 City State Zip Code
CAPTCHA

Membership Form