President: Harold Peek 816-662-4190 Vice-President: Ryan Frakes 816-688-7820 
Treasurer: Sandra Justice 660-446-3440 Secretary: Beth Wilson
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REGISTRATION FORM 2010 SEASON
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 set-up fee for each market day is $10.00 per stall.
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: ______________________________________________________________________________
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 Paid Membership Fee _________________________________________________ Date Board Approved ___________________________________________________
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 Nicole Keck
4702 County Road 44
Fillmore, MO 64449
*Checks should be made payable to the Pony Express Farmer’s Market.
