Membership Agreement Template
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1
2Membership Agreement
New member
Renewing member
First name:
Last name:
Member #:
Street:
City:
State:
Zip:
Volunteering?
yes
no
maybe
Phone
:
Email:
(best #)
Email me about Co-op sales and upcoming community events:
yes!
no, thanks
Tell us more about your
Do you prefer an alternative to email for important membership updates?
phone
SMS
interests on the back!
Are you joining / renewing
First name:
Member #:
as a household
Last name:
(2+ people at a single address)?
Phone
:
Volunteering?
(best #)
yes, second person here
yes
no
maybe
no
Email:
Email me about Co-op sales and upcoming community events:
yes!
no, thanks
Tell us more about your
Do you prefer an alternative to email for important membership updates?
phone
SMS
interests on the back!
If you’re a new member... equity!
If you’re a renewing member... renewal fee!
Every member builds the Co-op with an equity
Happy anniversary! Those who are ALREADY members
investment. This is the $100 purchase of your Co-op
renew our membership each year with a $20 fee ($30 for
share ($150 for households) OR it’s your sweat equity
households).
volunteer work.
Regardless of how your equity was completed, we all chip
You only pay equity once, when you join as a new
in to support the Co-op financially when we renew!
member. The annual fee is waived for new members!
If you’re a new member, choose your equity plan:
Payment
I’m buying my share in full: $100 ($150 for households).
Amount enclosed for equity:
$
I’m paying in $25 installments every three months.
Amount enclosed for renewal fee:
$
I’m applying for sweat equity. (If a student or
Total amount enclosed:
$
economically qualified, this is ten hours of volunteer time.)
Terms of Agreement:
I have paid the membership fee as required. I understand the privileges and terms of membership in the George Street
Co-op, Inc. and I am aware that non-compliance with this agreement may result in loss of membership. I understand that my membership card is not
transferable, and it is my responsibility to notify the Co-op management if it is lost or stolen. The card must be surrendered upon termination of
membership. (Please note: Half of your equity is a non-refundable investment in our Co-op. The other half is refundable if requested within one year
of non-renewal. Please allow 90 days for refund requests to be processed.)
Signature: ____________________________ Date: __________
Signature: ____________________________ Date: __________
Payment & form received by cashier
Date:
Cash
Credit/Debit
Check (#________ )
:
Payment and form received by
__________________________________
Date:____________________
:
Payment and database processed by: _____________________________
Date:____________________
Agreement form filed by: _______________________________________
Date:____________________
Orientation given by: __________________________________________
Date:____________________
Student ID / sweat equity qualification verified by: _________________
Date:____________________
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