Moscow Food Co-op Membership Application

Please fill in the following information and print this form. You may either bring it to the Co-op or mail it with your membership dues to:

Moscow Food Co-op
P.O. Box 9485
Moscow, ID 83843

Name
Address
City
State	Zip code
Email
phone
Number of adults in household:
Names of additional adults
New Membership Renewal
Dues Membership Dues are $10.00/year for a single member. For each additional adult (18 years & older) in the same household, add another $7.00/year.
Single membership: $10 Two-person membership: $17 Senior: $5 Lifetime membership: $150 Other: list amount: _____ Member Card Statement: With every purchase through our Point of Sale (POS) system, the Moscow Food Co-op benefits from vital data regarding product inventory and sales that helps us streamline stocking and purchasing functions and to improve product selection, availability and pricing. Additionally when you use your membership scan card, the POS system associates data from your purchases with your member ID. Although the system tracks purchases we will never give or sell this or any other member information to any individual or organization. If you prefer that we do not collect your purchase data please use the temporary card that you were issued today. Please sign below to acknowledge that you agree to allow the Co-op to scan your membership card. Member signature *Note: If you choose not to sign this form, you will still receive all the benefits of membership, and you will receive a non-scannable card.*

Please print this form. You may either bring it to the Co-op or mail it with your membership dues to:

Moscow Food Co-op
121 E 5th St.
Moscow, ID 83843

Your Membership card will be mailed to you.