Step 1 of 6 16% 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 InformationGet ready to save! Please enter your insurance agent's information here.Agent*- Select an Agent - Kinney Pike Ins Inc-Rutland Kinney Pike-Randolph Kinney Pike-White River Jct Jared Jabaut Agency Perkins Insurance Agy Inc The Blondin Agency Inc Blosser Insurance, Inc.Rosaire A. Levesque Paige & Campbell Inc Frazer Agency Inc Mullen Insurance Agency IncThomas W. HungerfordJaimes L. Fewer Chalmers Ins & Fin Svc Inc D R Miller Agency IncorporatedJoel AngelovicDennis BlodgettTimothy J. GuaraldiTom Heins NSS Des Moines NSS LynchburgThis field is hidden when viewing the formAgent ID*This field is hidden when viewing the formAgent Name*Agent Number*Agent Email Agent Phone Number Contact InfoMembership Number* First Name Middle Name Last Name This field is hidden when viewing the formBirthdate YYYY dash MM dash DD Spouse's First NameSpouse's Last NameThis field is hidden when viewing the formSpouse's Birthdate MM slash DD slash YYYY Email Address (This field is required to make an online payment)* County*- Select -AddisonBenningtonCaledoniaChittendenEssexFranklinGrand IsleLamoilleOrangeOrleansRutlandWashingtonWindhamWindsorAll CountyHome PhoneWork 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 Farm InfoFarm NameSize of Farm Operation- Select -SmallMid-SizeLargeCommodities ProducedNo Commodities ProducedApiary - Bee KeeperApiary - HoneyApplesAquaculture - TroutAquaculture/Fish FarmingBed & BreakfastBedding PlantsBeef - GeneralBeef - Grass Fed Highlander BeefBeef - VealBeef CattleBerries - BlackberriesBerries - BlueberryBerries - CranberriesBerries - ElderberriesBerries - GeneralBerries - RaspberriesBerries - StrawberriesBerries - Wild BlueberriesBoardingCattle DealerChinchillasChristmas TreesChristmas WreathsCorn - GeneralCorn - GrainCorn - H.M. Ground Ear CornCorn - High Moisture CornCorn - SilageCorn - Sweet CornCreameryCrops - CanolaCrops - CottonDairy - GeneralDairy - MilkDairy - Raw Cow DairyDairy - ReplacementDeerDeer - Red DeerDiversified FarmDonkeysEmusEquineExotic AnimalsFarm MarketFarm StandsFarm SuppliesFeed MillField Crops - BarleyField Crops - BuckwheatField Crops - Buckwheat FlourField Crops - Forage CropsField Crops - GeneralField Crops - MiloField Crops - OatlageField Crops - OatsField Crops - RyeField Crops - SorghumField Crops - Soy/Feed GrainField Crops - SoybeansField Crops - SpeltzField Crops - VetchField Crops - WheatFir TreesFishermanFleeceFloricultureFloriculture - Cut FlowersFloriculture - FloristForesterForestry - FirewoodForestry - GeneralForestry - Woodlawn ProductsFruits And Nuts - GeneralFruits And Nuts - Small FruitsFruits/Vegetables - GeneralGardens - Personal UseGoatsGoats - Boer GoatsGoats - Dairy GoatsGoats - Goat CheeseGoats - Goat ProductsGrains - GeneralGrapes - GeneralGreenhousesHay - GeneralHay - AlfalfaHay - Clover HayHay And Straw - GeneralHeiferHeifers - Jersey HeifersHemp - CannabisHerbs - GeneralHobby FarmHogs/SwineHogs/Swine - PigsHoof TrimmerHops GrowerHoritculture CropsHorse TrainerHorses - GeneralHydroponics - GeneralLand - Lease LandLand - Rent LandLandscaperLivestock - GeneralLlamas/AlpacasLoggingMaple SyrupMeat ProcessingMulchMushroomsNursery StockNursery/Greenhouse - GeneralNuts - GeneralOrchards - CherriesOrchards - GeneralOrchards - NectarinesOrchards - PeachesOrchards - PearsOrchards - PlumsOrganic - DairyOrganic - PotatoesOrganic - VegetablesOrganicsOrnamental Horticulture CouncilOstrichesPastures MeatPetsPoultry - ChickenPoultry - BroilersPoultry - DucksPoultry - EggsPoultry - GeesePoultry - GeneralPoultry - LayersPoultry - MeatPoultry - Meat - RetiredPoultry - TurkeysPoultry ProducerProcessing PlantRabbitsRetailSaw MillsSeed PotatoesSeed SalesSeeds - GeneralSeeds for VegetablesSheep - GeneralSheep - LambsSheep - ProducerSheep - WoolSlaughterhouseSmall Fruit and VegetablesSpecialty Crops - GeneralStorage for EquipmentStrawTimberTobaccoTomatoesTrainingTraining and Horse SalesTree FarmTurfVegetables - BeansVegetables - BroccoliVegetables - CabbageVegetables - GarlicVegetables - GeneralVegetables - PeasVegetables - PeppersVegetables - PotatoesVegetables - Potatoes- RetiredVegetables - ProduceVegetables - RetiredVegetables - Snap BeansVegetables - Sweet PotatoesVeterinary ServicesVineyardVining Crops - CucumbersVining Crops - GeneralVining Crops - PumpkinsVining Crops - SquashWholesaleWholesale & DirectWork in Ag ServicesYogurtVetchOther/Unknown This field is hidden when viewing the formPolitical Party Democrat Republican Independent Prefer Not To Answer Signed Up by (Member Number)Referred byComments 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*- Select a Reason -AFBF Convention FundAnnual Meeting FundLegislativeGold Card (Changed to Mbr Class)Agricultural EducationLegal FundMiscellaneous ContributionAll County BenefitScholarship FundNick Kenyon Memorial FundAmount* 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 This field is hidden when viewing the formPayment Method* Credit Card Credit Card* MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Address* 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