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I am...
Please select your membership type below.*
- Regular/Farmer
- Regular/Retired
- Forester
- Associate/Non Farmer
- Business/Organization
- Other States Member
- VTFB Employee
Are you an insurance agent, or are you working with an insurance agent?*
- Yes
- No
Insurance Information
Get ready to save! Please enter your insurance agent's information here.
Agent*
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Agent ID*
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Agent Name*
Agent Number*
Agent Email
Agent Phone Number

Contact Info
Membership Number
*
First Name Middle Name Last Name
Birthdate
YYYY dash MM dash DD
Spouse's First Name
Spouse's Last Name
Spouse's Birthdate
MM slash DD slash YYYY
Email Address (This field is required to make an online payment)*
County*
Home Phone
Work Phone
Cell Phone
Address*
Street Address Address Line 2 City State Zip Code
Township(s) you are located in
Farm Info
Farm Name
Size of Farm Operation

Commodities Produced

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Political Party
- Democrat
- Republican
- Independent
- Prefer Not To Answer
Signed Up by (Member Number)
Referred by
Comments or Requests

Subscription Auto Renewal*
By checking this box, I authorize Vermont 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 Vermont 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 will be provided in an annual reminder email. I understand refunds will not be issued after a payment has processed. Contact methods: Phone—802.434.5646; Email—vtfb@gmavt.net; Mail—Vermont Farm Bureau, 97 State Street Ste 2, Montpelier, VT 05602-3218.
- Yes
- No

Would you like to make a Donation?
- Yes
- No
Reason*
Amount*

Donation
Price: $0.00
Renewal 70
Price:
Renewal 75
Price:
Renewal 80
Price:
Renewal 85
Price:
Renewal 90
Price:
Renewal 600
Price:
Your annual membership is only:
$0.00
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Payment Method*
- Credit Card
Credit Card*

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Address*
Street Address Address Line 2 City State Zip Code

Vermont Farm Bureau
117 W Main St
Richmond, VT 05477