Application for garden plot

Please fill out the following form and return it to Beth at email@bethhenrikson.com. This form is also available in hard copy or soft copy (via email) upon request.

2009 Emporia Community Garden Application

Name:__________________________ Phone:___________ E-mail:______________________

Address:________________________________ City:__________________ Zip:___________

I give permission to share my contact information with other gardeners. ___yes ___no

Gardener profile: (please check all that apply)
__I am a new gardener requesting a plot.
__I am a returning gardener requesting: __the same plot OR __a plot change.
__I do not want a plot at this time, but am interested in volunteering with Emporia Community Garden Association.
__I am interested in: __taking and/or __teaching free gardening classes.
__I am interested in a second plot, if one becomes available.
__I am interested in a plot for raised beds when they become available.
__I would like a plot near my friend, if possible. Friend's name_________________________
__I plan to use the mid-season tilling services ($5/tilling)
__I would like to request a handicapped accessible plot.
__Please note the following information as you consider my application and assign my garden plot:


Please list the plants that you intend to grow this season, so that we may assign the best plot for your needs: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Signature: I have read the Emporia Community Garden rules and agree to abide by them. I agree that if I fail to abide by the rules, I forfeit my lot(s) and all remaining produce. As a voluntary participant, I recognize that no other individual or group is responsible in the event of injury to my family or myself.

Signature:________________________________________________ Date:_____________

Please make checks payable to Emporia Community Garden Association. Return completed application, along with $30 payment, to:
Emporia Community Garden Association
P.O. Box 100
Emporia, KS 66801

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Plot #___________ Payment received: cash___ check___ date_______ by_____ (initials)

Notes: