GROWN LOCAL Online Application

Question.1

Name *

First Name

Last Name

Question.2

Email address *

Email

Question.3

Business name *

Question.4

Website

Question.5

Mailing / billing address *

Address Line 1

Address Line 2

City

State

Zip Code

Question.6

Contact / business phone *

Phone Number

Question.7

Cell phone

Phone Number

Question.8

Fax

Phone Number

Question.9

What information would you like included on the GROWN LOCAL Marin / buylocalmarin.org website? *

Please email all artwork (photos, logos, etc.) for your GROWN LOCAL Marin profile to sarah@agriculturalinstitute.org.

Contact / business phone
Address
Email
Logo
Website
Business profile (below)
No information

Question.10

Please include a brief (50-75 words) profile of your business and products. *

Question.11

By chceking the boxes on the following criteria, the "undersigned" confirms that he / she: *

a) Has read the Rules.
b) Understands that compliance with the Rules is a requirement of continued participation in GROWN LOCAL Marin and that failure to comply may result in action including removal from program and repossession of sign and marketing materials.
c) Understands that the Rules address multiple topics, including participant selection, site visit/audits, non-compliance, and removal from program.
d) Understands that the Rules allow the GROWN LOCAL Marin Committee and Agricultural Institute of Marin (AIM) to conduct audits of the undersigned’s stall, farm/ranch, store, and other facilities, if necessary, and consents to such audits and to disclosure of the audit results.
e) Confirms that the information contained in the undersigned’s application and other statements made to AIM is accurate and complete.
f) Confirms that, if signing on behalf of a corporation, limited liability company, partnership, or other legal entity, the undersigned has the legal capacity and authorization to enter this agreement on behalf of that entity.
g) Accepts and agrees to comply with all of the provisions of the Rules.

Question.12

Please print your full name in the following text box to confirm your understanding of and agreement to each of the terms and conditions set out in the GROWN LOCAL Marin County rules and criteria for producers (the “Rules”). Your entry into this agreement and your continued compliance with the Rules is a requirement for participation and use of GROWN LOCAL Marin sign and materials. *

Question.13

Date *

MM
/

DD
/

YYYY

Question.14

Are you being sponsored for this membership?

Yes
No