Step 1 of 5 20% Membership PriceI am...Please select your membership type below.* $250 - Farmer greater than $10,000 in gross farm income $100 - Farmer less then $10,000 in gross farm income/Farm employee $50 - Retired farmer (no farm income) $250 - Business Supporter/Service Provider $75 - Supporter/Non-Farmer $30 - Student supporting member Are you an insurance agent, or are you working with an insurance agent?* Yes No Insurance InformationGet ready to save! Please enter your insurance agent's information here.Agent Name*Agent Number*Agent Email* Agent 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 - GeneralCorn - H.M. Ground Ear CornCorn - High Moisture CornCorn - SilageCorn - Sweet CornDairy - GeneralDead Animal HaulerDeerDeer - Red DeerElkEmusEquipment DealersExotic AnimalsFarm MarketFarm SuppliesFeedersField Crops - BarleyField Crops - BuckwheatField Crops - GeneralField Crops - MiloField Crops - OatlageField Crops - OatsField Crops - RyeField Crops - SorghumField Crops - SoybeansField Crops - SpeltzField Crops - WheatFloricultureForestry - Forest ProductsForestry - GeneralForestry - Wood/Paper ProductsFruits And Nuts - GeneralFuel SalesFurbearing AnimalsGame BirdsGarbage HaulerGoatsGrains - GeneralGrapes - GeneralGreenhousesHay - AlfalfaHay - Clover HayHay - Grass HayHay And Straw - GeneralHeifers - Bred Dairy HeifersHeifers - Yearling Beef HeifersHogs/SwineHogs/Swine - Feeder PigsHogs/Swine - SowsHorses - GeneralHydroponics - GeneralLivestock - GeneralLlamas/AlpacasLoggingManure HaulingMaple SyrupMarket/Gourmet FishMushroomsNursery StockNursery/Greenhouse - GeneralNuts - GeneralOrchards - CherriesOrchards - GeneralOrchards - NectarinesOrchards - PeachesOrchards - PearsOrchards - PlumsOrganic ProductionOstrichesPeat MossPoultry - ChickenPoultry - DucksPoultry - EggsPoultry - GeneralPoultry - LayersPoultry - MeatPoultry - TurkeysSafemark DealerSaw MillsSchool BusSeed SalesSheep - GeneralSpecialty Crops - GeneralStone QuarryTobaccoTomatoesVegetables - 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 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
