Farm Leadership Council

membership / registration

FLC Membership Subscription Form

THE UNDERSIGNED HEREBY APPLIES for a membership in the Farm Leadership Council LTD. THE UNDERSIGNED HEREBY AGREES to observe and to be bound by the rules, policies and by-laws of the Co-operative and that: the undersigned is 18 years of age or older; and the undersigned falls within at least one of the following categories: an individual or partnership actively engaged in farming for commercial purposes; or a farming corporation actively engaged in farming for commercial purposes.
Last Name:
Given Name:
Address 1:
Address 2:
Address 3:
City:
Province:
Country:
Postal Code:
Phone:
Fax:
Cell:
Email:
Designated Home Quarter:	RM/County
	SEC TWP
	RGE MER
Please indicate if applicant is:	(a) Farming Corp.
	(b) Partnership
	(c) Registered Partnership
	(d) Registered Co-operative
	(e) Sole or Joint Ownership
	(f) Hutterite Colony
	(g) Non Farming Corp
	(h) Indian Band
If a, b, c, d above, please print name of principle shareholder:
If applicable please provide Business Identification number:


I hereby agree to allow my contact information to be used by the Farm Leadership Council for the purpose of membership lists, communications, database, etc.