President: Ryan Frakes       (816) 390-2961                   Vice-President: Penny Dieberger   (816) 593-2419
             Treasurer: Sandra Justice    (660) 446-3440                    Secretary: Dawn Forsberg            (816) 390-8209        

                         .................................................................................................................
                           _________ MARKET REGISTRATION FORM 

Date:________________

I am applying for membership with the Pony Express Farmer’s Market.

I understand:  *The membership fee is $75.00 annually and is non-refundable. *The pre-paid stall fee is $285.00; then, $5.00  
for the first stall and $10.00 for each additional stall. The pre-payment of $285.00 must be paid in full by July 1st. 

Which best describes your operation?
Commercial Grower __________Part-time Grower ___________ Backyard Gardener _________Organic Grower
____________ Other, explain: ___________________________________________________________________________
Have you ever sold at this Farmers' Market? _______Yes  _______ No

Name of Farm/Business: _______________________________________________________________________________
Owner/ Manager: _____________________________________________________________________________________
Address: ____________________________________________________________________________________________
City/State/Zip:_______________________________________________________________________________________
Phone# ____________________________________________ E-Mail: _________________________________________
Sales Tax #____________________ Business Licence #____________________ Health Permit #_____________________
Directions to Farm/Garden: _____________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
We are interested in maintaining product availability / variety at the market.   Please list what you plan to sell:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Will you be attending on: ______Wednesdays ______ Saturdays      Number of spaces requested: ______ One ______ Two
Electricity requested: ______Yes ________ No

I have read the Market Rules & Regulations and the Bylaws and agree to abide by them.
Signed: ________________________________________________________      Date Board Approved ________________

Date Membership Fee Paid ________________________ Date Pre-Paid Stall Fee Paid: _____________________________
  
Please bring this form along with the $75.00 membership fee to the general meeting, market site or mail to: 
Pony Express Farmer’s Market
c/o Sandra Justice
408 W. Elm St.
Oregon,  MO.  64473

*Checks should be made payable to the Pony Express Farmer’s Market.