Step 1 of 6 16% Membership PriceI am...Please select your membership type below.* $250 - Farmer greater than $10,000 in gross farm income $100 - Farmer less then $10,000 in gross farm income/Farm employee $50 - Retired farmer (no farm income) $250 - Business Supporter/Service Provider $75 - Supporter/Non-Farmer $30 - Student supporting member This field is hidden when viewing the formAre you an insurance agent, or are you working with an insurance agent?* Yes No This field is hidden when viewing the formInsurance InformationGet ready to save! Please enter your insurance agent's information here.This field is hidden when viewing the formAgent*- Select an Agent -Sally Gaynor-KnechtAndy JellieDarrell LouisMike BertoloneCaleb KirbySteve FountainPeter BarachValerie ArmstrongChristie BrownBrandon CoffmanNick MillerKyle BaylisEmmalee BauckmanEmily VanDurenDee TreybigDarryn MartinJoe FitzgeraldKevin PowersRichard IsabelleBrittany IsabelleThis field is hidden when viewing the formAgent Number*This field is hidden when viewing the formAgent Email This field is hidden when viewing the formAgent Phone Number Contact InfoMembership NumberPrimary Member First Name Middle Name Last Name Birthdate MM slash DD slash YYYY Spouse's First NameSpouse's Last NameSpouse's Birthdate MM slash DD slash YYYY Email* County*BELKNAPCARROLLCHESHIRECOOSGRAFTONHILLSBOROUGHMERRIMACKROCKINGHAMSTRAFFORDSULLIVANHome Phone*Work PhoneCell PhoneAddress* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Code Town/Township(s) you are located in Business/Farm InfoBusiness/Farm NameSize of Farm Operation- Select a Farm Size -Unknown SizeNone< 1 Acre00 - 49 Acres50 - 99 Acres100 - 249 Acres250 - 499 Acres500+ AcresCommodities ProducedNo Commodities ProducedAgritourismAlpacasApiary - Bee KeeperApiary - HoneyApplesApples/FreshAquaculture - Bait FishAquaculture/Fish FarmingBeef - GeneralBeef CattleBerries - BlueberryBerries - GeneralBisonBreweryButcherChristmas TreesCorn - GeneralCorn - GrainCorn - SilageCorn - Sweet CornDairy - GeneralDeerDeer - Red DeerEmusEquineFarm MarketFarm StandsFarm SuppliesField Crops - Forage CropsFloricultureForestry - Forest ProductsForestry - GeneralForestry - Wood/Paper ProductsFruits And Nuts - GeneralFruits/Vegetables - GeneralGoatsGrains - GeneralGrapes - GeneralGreenhousesHay - GeneralHay - Grass HayHay And Straw - GeneralHerbs - GeneralHogs/SwineHogs/Swine - Feeder PigsHorses - GeneralHydroponics - GeneralLandscaperLlamas/AlpacasLoggingMaple SyrupMushroomsNursery/Greenhouse - GeneralOrchards - CherriesOrchards - GeneralOrganicsPheasantsPoultry - ChickenPoultry - EggsPoultry - GeneralPoultry - LayersPoultry - TurkeysRabbitsSeed SalesSheep - GeneralTurfVegetables - GeneralVeterinary ServicesVineyard - Wine & SpiritsVining Crops - PumpkinsWork in Ag ServicesOther ProductAg CommissionAg Event HostingAmerican Guinea HogsAnimal ProductsArboricultureBaked GoodsCash CropsDog GroomerEducationElectricianEntertainmentFamily RestaurantFarrierFiber ProductsGuinea FowlHandcrafted Wood BowlsHandiworkHVACPortable ToiletsRancher MTReal Estate ServiceSeptic ServicesSmoked MeatsSoil AmendmentsSolarSoy CandlesSoy-Free PorkSpecialty FoodsTherapy Adaptive ServicesWorm CastingsAg Service ProviderFarm Stays Current Commodities This field is hidden when viewing the formPolitical Party Democrat Republican Independent This field is hidden when viewing the formSigned Up by (Member Number)Signed By / Referred byComments or Requests Subscription Auto Renewal*By checking this box, I authorize New Hampshire Farm Bureau to annually charge my credit or debit card at the then-current annual membership dues rate. To discontinue auto-renewal billing, I understand that I must notify New Hampshire Farm Bureau by one of the below contact methods, at least one week prior to the auto-renewal billing date. I understand refunds will not be issued after a payment has processed. Contact methods: Phone—603.224.1934 Email—finance@nhfarmbureau.org Mail—New Hampshire Farm Bureau, Attn: Member Services, 295 Sheep Davis Road, Concord, NH 03301. Yes No Would you like to make a Donation? Yes No Reason*- Select a Reason -NHFB DonationYoung FarmersAssociated WomenAITC-Ag In The ClassroomAmount* Donation Price: $0.00 Renewal 100 Price: Renewal 250 Price: Renewal 75 Price: Renewal 50 Price: Renewal 30 Price: Your annual membership is only: $0.00 This field is hidden when viewing the formPayment Method* Credit Card eCheck Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Expiration Date Security Code Cardholder Name eCheckAddress* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Code
