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 Are you an insurance agent, or are you working with an insurance agent?* Yes No Insurance InformationGet ready to save! Please enter your insurance agent's information here.Agent Name*Agent Number*Agent Email* Agent Phone Number* Contact InfoMembership Number* 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*NEW HAMPSHIREBELKNAPCARROLLCHESHIRECOOSGRAFTONHILLSBOROUGHMERRIMACKROCKINGHAMSTRAFFORDSULLIVANHome 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 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 Political Party Democrat Republican Independent Signed Up by (Member Number)Referred byComments or Requests Subscription Auto Renewal*By checking this box, I authorize Alaska 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 Alaska Farm Bureau by one of the below contact methods, at least one week prior to the auto-renewal billing date. The exact auto-renewal date (generally October 15) will be provided in an annual reminder email. I understand refunds will not be issued after a payment has processed. Contact methods: Phone—907.252.5064 Email—info@alaskafb.org Mail—AK Farm Bureau, Attn: Member Services, 1696 N Clearwater Ave, Delta Junction, AK 99737. 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 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 Expiration Date Month010203040506070809101112 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 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
