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I am...
Please select your membership type below.*
- Farming: Basic (Gross Income < $100,000) - $89.00
- Farming: Supporter (Gross Income $100,000 to $200,000) - $100.00
- Farming: Contributor (Gross Income > $200,000) - $125.00
- Non-farming: Associate (farm-related business) - $89.00
- Non-farming: Agricultural Organization - $200.00
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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 Name*
Agent Number*
Agent Email*
Agent Phone Number*

Contact Info
Membership Number*
Name*
First Name Middle Name Last Name
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Birthdate
MM slash DD slash YYYY
Spouse's First Name
Spouse's Last Name
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Spouse's Birthdate
MM slash DD slash YYYY
Email*
Home Phone*
Work Phone
Cell Phone
Address*
Street Address Address Line 2 City State Zip Code
County*
Town/Township(s) you are located in
Farm Info
Farm Name
Size of Farm Operation

Commodities Produced

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

Subscription Auto Renewal*
By checking this box, I authorize Maine 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 Maine 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.
- Yes
- No

Farming Contributor 125
Price:
Farming Basic 89
Price:
Non Farming Associate 89
Price:
Farming Supporter 100
Price:
Non Farming Agricultural Organization 100
Price:
Your annual membership is only:
$0.00
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Credit Card*

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Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
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Address*
Street Address Address Line 2 City State Zip Code
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Maine Farm Bureau Association
4 Gabriel Drive, Suite 1

Augusta, Maine 04330