Step 1 of 6 16% Membership PriceI am...Please select your membership type below.* General Double General Century Club Double Century Club Associate Junior Member This field is hidden when viewing the formAre you an insurance agent, or are you working with an insurance agent?* Yes No This field is hidden when viewing the formInsurance InformationGet ready to save! Please enter your insurance agent's information here.This field is hidden when viewing the formAgent Name*This field is hidden when viewing the formAgent Number*This field is hidden when viewing the formAgent Email* This field is hidden when viewing the formAgent Phone Number* Contact InfoMembership Number* First Name Middle Name Last Name Birthdate* MM slash DD slash YYYY Spouse's First NameSpouse's Last NameSpouse's Birthdate MM slash DD slash YYYY Email* County*Copper River ValleyDelta JunctionFairbanksNorth Kenai Peninsula Kodiak Mat-SuSouth Kenai PeninsulaHome Phone*Work PhoneCell PhoneAddress* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Code Township(s) you are located in Business/Farm InfoBusiness/Farm NameSize of Farm Operation- Select a Farm Size -Unknown SizeNoneTiny Less than 1 AcreSmall 01 - 25 AcresMid 26 - 99 AcresMedium 100 - 500 AcresLarge 501 - 1000 AcresVery Large 1001+ AcresCommodities ProducedNo Commodities ProducedAgritourismAlpacasAnimal Breeders - GeneralAnimal Breeders - Small AnimalsApiary - Bee KeeperApiary - HoneyApplesApples/FreshApples/ProcessedAquaculture - Bait FishAquaculture/Fish FarmingArtificial BreederBeef - GeneralBeef - VealBeef CattleBerries - GeneralBerries - StrawberriesBisonBreweryButcherCanine BreedersChristmas TreesCorn - GeneralDairy - GeneralDead Animal HaulerDeerDeer - Red DeerElkEquine - Learning CenterEquipment DealersExotic AnimalsFarm MarketFarm SuppliesFeed StoreFeedersField Crops - BarleyField Crops - BuckwheatField Crops - GeneralField Crops - MiloField Crops - OatlageField Crops - OatsField Crops - RyeField Crops - SorghumField Crops - SoybeansField Crops - SpeltzField Crops - WheatFloricultureForestry - Forest ProductsForestry - GeneralFruits And Nuts - GeneralFuel SalesFurbearing AnimalsGame BirdsGoatsGrains - GeneralGrapes - GeneralGreenhousesHay - AlfalfaHay - Clover HayHay - Grass HayHay And Straw - GeneralHeifers - Bred Dairy HeifersHeifers - Yearling Beef HeifersHogs/SwineHogs/Swine - Feeder PigsHogs/Swine - SowsHorse BoardingHorse TrainerHorses - GeneralHydroponics - GeneralLivestock - GeneralLlamas/AlpacasLoggingManure HaulingMaple SyrupMarket/Gourmet FishMushroomsNursery StockNursery/Greenhouse - GeneralNuts - GeneralOrchards - CherriesOrchards - GeneralOrchards - NectarinesOrchards - PeachesOrchards - PearsOrchards - PlumsOrganic ProductionOstrichesPeat MossPick Your Own VegPoultry - ChickenPoultry - DucksPoultry - EggsPoultry - GeneralPoultry - LayersPoultry - MeatPoultry - TurkeysSaw MillsSchool BusSeed SalesSheep - GeneralSpecialty Crops - GeneralStone QuarrySupplierTobaccoTomatoesVegetables - BeansVegetables - CabbageVegetables - GeneralVegetables - PeasVegetables - PeppersVegetables - PotatoesVeterinary ServicesVineyard - Wine & SpiritsVining Crops - CucumbersVining Crops - GeneralVining Crops - PumpkinsVining Crops - SquashVetchOther/UnknownAquaculture - HatcheryAquaponicsAreoponicsAuctioneerBerries - NagoonberryChrismas ShowsDeer - ReindeerDeer - Reindeer BreedingFarm TransportationFloriculture - PeoniesFlower RetreatHay - Brome GrassHerbs - RhodiolaNutraceuticalsPermaculture and Regenerative Soil CertificationPoultry - Sebastopol GoslingsSeeds - Grass SeedTissue CultureTractor ServicesVegetables - LettuceVegetables - MicrogreensVegetables - RhubarbWedding VenuesYakYarn Current Commodities Political Party Democrat Republican Independent Signed Up by (Member Number)Referred byComments or Requests Subscription Auto Renewal*By checking this box, I authorize Alaska Farm Bureau to annually charge my credit or debit card at the then-current annual membership dues rate. To discontinue auto-renewal billing, I understand that I must notify Alaska Farm Bureau by one of the below contact methods, at least one week prior to the auto-renewal billing date. The exact auto-renewal date (generally October 15) will be provided in an annual reminder email. I understand refunds will not be issued after a payment has processed. Contact methods: Phone—907.252.5064 Email—info@alaskafb.org Mail—AK Farm Bureau, Attn: Member Services, 1696 N Clearwater Ave, Delta Junction, AK 99737. Yes No Would you like to make a Donation? Yes No Reason*- Select a Reason -Friends of Ag FoundationAmount* Product Name Price: $0.00 Renewal 100 Price: Renewal 200 Price: Renewal 400 Price: Renewal 15 Price: Your annual membership is only: $0.00 This field is hidden when viewing the formPayment Method* Credit Card eCheck Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name eCheckAddress* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Code
