Kent Natural Food Cooperative
Application For Membership
Name: ___________________________ Age:____ D.O.B.__________
Last First
Address:__________________________Phone: (____)_____________
Occupation:____________________________
Others in household to be served by Membership: (eighteen years old and under)
Name:_____________________________ Age:____ D.O.B._____________
Name:_____________________________ Age:____ D.O.B._____________
Name:_____________________________ Age:____ D.O.B._____________
Upon Termination of membership, or dissolution of
Cooperative Market. In the event that I should not be able to be
located for the return of my owners investment. I hereby instruct and
authorize the cooporation to dispose of said investment as
follows:___________________________________________________________________
_________________________________________________________________________________________
I hereby apply for membership in the Cooperative Market and Agree to comply with the rules and regulations thereof:
Signature:________________________________________ Date:_________________
Please mail this form with your payment of ($45 full
payment, or $20 partial) to:
KNF CO-OP
151 E. Main,
St
Kent, OH 44240
Or drop it off in person. Thank You
!