08-09 Enrollment Form

Ready to start helping local schools? Enrolling easy, free, and quick as can be.

To enroll, you will need:

• A Farmer's 4 Good card
• About one minute of free time
• ...that's it!

Don't have a card yet? No problem! Stop by Farmer's Market today to pick yours up. You don't have to be a parent to join, either; anyone who wants to help out our schools is encouraged to join!

Required Information

Enter the ID number from your card here. This will be a 19 digit number on '08-'09 cards, and a 2 digit number on '09-'10 cards.

Card Number:

Here at Farmer's, we know our customers by name.

First Name:
Last Name:

We won't tell anyone how old you are, but we will send a coupon on your birthday!

Date of Birth: January February March April May June July August September October November December   01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996

Unless you want us to call you at 4am when we find something really good on the market.

Email:

What school is going to love you for raising a bunch of money?

School: 17th St. Assoc. 42 Foundation Abraham Lincoln Backstoppers Belle Valley South Belleville Humane Society Belleville Jaycees Belleville Optimist Club Bethany Place Big Brothers Big Sisters Blessed Sacrament Bridges Program C.A.S.A. Caring Hearts Cathedral Grade School Central Junior High Christ United Cornerstone Christian Douglas Emge / Ellis Family Hospice First Christian Church Franklin Grant Middle School Henry Raab High Mount Holy Trinity Hospice of Southern Illinois Illinois Center for Autism Jefferson Legacy Academy Millstadt Primary Center Office on Aging Partners Partners Pontiac Junior High PSOP SWIC Programs & Services for Older People PTOEC (Special Olympics) Roosevelt S.M.S.A Shiloh Elementary School Signal Hill Smithton St. James ECC St. John the Baptist St. Paul's MDO St. Teresa Swansea Patriots Union Violence Prevention Center Washington West Junior High Westhaven Whiteside Elementary Wm. Holiday Wolf Branch Zion Lutheran

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