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Winegrower Member Application
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Winegrower Member Application
Winegrower Member Application & Dues
Company Name
*
Vineyard Name
*
Main Business Representative
*
Office Email
*
Office Phone
*
Vineyard Address
Street Address
Address Line 2
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State
ZIP Code
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Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
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New York
North Carolina
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
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Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Additional Information
This information is welcomed but not required
Owner/CEO & Email
Vineyard Manager & Email
Accounting Manager & Email
Varietals Grown
This information is welcomed but not required
Varietal Grown and Acres Planted
Varietal Grown and Acres Planted
Varietal Grown and Acres Planted
Varietal Grown and Acres Planted
Varietal Grown and Acres Planted
Varietal Grown and Acres Planted
Varietal Grown and Acres Planted
2018 Member Winegrower Dues
Membership dues are $2.50 x Winegrape Tons Grown. There is a minimum $300 and maximum $5000.
Total Winegrape Tons Grown
*
120 Tons or Less
Between 120 and 2000 Tons
Over 2000 Tons
Exact Winegrape Tons Grown
*
Please enter a number from
120
to
2000
.
This number calculates your membership dues
Total Amount Due
*
Price:
$0.00
Minimum Payment
Price:
$300.00
For winegrower members with less than 120 winegrape tons grown
Maximum Payment
Price:
$5,000.00
For winegrower members with more than 2000 winegrape tons grown
Pay with Credit Card
American Express
Discover
MasterCard
Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
Expiration Date
Security Code
Cardholder Name
Pay with Check
Yes, I will be paying by check
Make check payable to Alexander Valley Winegrowers. Please send checks to PO Box 248, Healdsburg CA 95448.
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