Wufoo

THE OFFICE: 120 West Broadway, Eugene, OR 97401 OPEN: In season, T-F, 10 am - 4 pm
THE PHONE: (541) 431-4923 / Voice; (541) 338-7164/ Fax
THE WEB: info@lanecountyfarmersmarket.org; www.lanecountyfarmersmarket.org *
Saturdays (April 3 - Nov 13) Tuesdays (May 4 - Oct 26) Thursdays (June 3 - Sept 30)
Name * First Last
Business / Farm Name
Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Business / Farm Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Number *
Business Contact Number
Email
Web Site
Co-Sellers or Co-Sharers: See (Handbook)
Include phone number(s)
YES, LCFM can publish the above information on our website.
New or Renewal?
New Renewal
Years in Business
Acres in Use
Own or Lease? *
own lease
Cumulative Years Vendor at the LCFM? *
Important note to applicants:

A complete application will include the following:
Completed application $35 member fee
Where appropriate:
Tilth Organic certificate
expiration date: MM / DD / YYYY
Kitchen certificate
expiration date: MM / DD / YYYY
Contract for use of Commercial Kitchen
expiration date: MM / DD / YYYY
Food handlers permit
expiration date: MM / DD / YYYY
Low Acid Certificate, OSU
expiration date: MM / DD / YYYY
Temporary Restaurant License
expiration date: MM / DD / YYYY
Nursery license
expiration date: MM / DD / YYYY
OLCC permit for wine/beer
expiration date: MM / DD / YYYY
Dairy Processor’s License
expiration date: MM / DD / YYYY
Meat Sellers License
expiration date: MM / DD / YYYY
Scale Certification
expiration date: MM / DD / YYYY
Certificate of Insurance (required) *
Yes
Others:
Attach all relevant documents via file upload OR mail by deadline.
Please update LCFM with any licensing changes as they occur.
APPLICANT'S PRODUCT

Application and products accepted at one Lane County Farmers Market (for example, Saturday) does not imply acceptance to any other LCFM markets. Each market application to be considered on a market-by-market basis.

In listing of products below, note any items that will be offered exclusively on specific days.

All applicants will be notified by email or mail of products accepted at which market and
which products do not pass the jury process.

Consignment vendors will also need to provide the above information. It should also
be noted that there will be No Carry Over for consignors. Consignors will need to make
all arrangements for set-up and takedown outside of LCFM venue. Staff will not be
available for assisting takedown or set-up.
PRODUCT LABELING
Please indicate your production method. Members are required to accurately label their products for sale at the all of the Markets. Please see the Member Handbook for the Rules & Guidelines of accepted titles and definitions.

Certified Organic Naturally Grown No Synthetics Applied Conventionally Grown Wildcrafted/Collected
Other:
PRODUCT CLASSIFICATION

Please list all of the products that you grow or produce and intend to sell at Lane
County Farmers Market. In all categories, priority for selection will be toward
“local” foods, that is those grown within Lane County or bordering counties, in-
cluding Linn, Benton, Deschutes, and Douglas. Use the Member Handbook and the
Rules & Guidelines for assistance in determining your product categories.
Please be specific and thorough. Changes and amendments during the year
should occur as needed. Use extra paper if needed.
I. GROWN BY MEMBER
Vegetables:
Fruits:
Nursery (requires nursery certificate):
Herbs:
Fresh Flowers:
Nuts:
Mushrooms:
Other:
II. GROWN OR PROCESSED BY MEMBER

(Most of these require certified Kitchen License. See Members Handbook or ODA.) Jams / Jellies, Honey / Beeswax, Eggs, Vinegars, Ciders, Butter, Cheese, Dried Flowers, Dried Herbs, Dried Fruit. Gourds, Bagged Greens, Meat, Wool, Firewood.
Product:
If Processor, a majority of ingredients must be purchased from local growers. List products and source:
III. GROWN BY MEMBER AND CRAFTED/PRODUCED

Dry Arrangements, Garlic Braids, Wreaths, Decorated Gourds, Feathers
Product:
IV. COLLECTED/WILD-CRAFTED STRICTLY REGULATED

IV-A Non-Fungus: Fish, Grasses, Flowers, Plants, Driftwood, Seashells, Wild Berries, Tree Fruit, Perennials, Evergreen Boughs, Cones, Lava Rock.
Product:
Product:
V. FOODS PREPARED BY MEMBER

Breads, Pastries, Confections, Coffee, Beer, Wine, Food consumed on site.
Due to our preference in choosing local/member sources for prepared foods, please list ingredients and source.
Products:
VI. CRAFTED BY MEMBER

Ceramics & Baskets that include plants, T-Shirts, Cards
Products:
MARKET PARTICIPATION

Use the Member Handbook with the Rules & Guidelines to assist you in completing this section. Please check or prioritize.
Select days on which you wish to participate: *
Saturdays (April 3 - Nov 13) Tuesdays (May 4 - Oct 26) Thursdays (June 3 - Sept 30)
What Type of Selling Will You Do? *
Vend my own items, in the space assigned. Consign my items in the Consignment Booth. Both Vend and Consign my items. (Consignment not available on Thursdays) Co-Sell though a Direct Agent.
What Size/Type of Area are you requesting?
Full Size Booth: Average 10'x10', ~100 sq ft; $40 each Booth space on Oak Street; $25 each
Number of contiguous booths (3 maximum)
Truck Vending space, 10’ frontage x 20’ deep, (very limited) Consignment: Determined daily / seasonally. $10 daily plus 30%
Which dates do you expect to start and end your season?

Pick the beginning and ending dates, otherwise check entire season
Beginning Date (April 3rd or later) MM / DD / YYYY
Ending Date (November 13th or earlier) MM / DD / YYYY
Entire Season?
Check here
MEMBER PROFILE

These questions are related to the Market and will help the management better understand
the membership and can lead to better planning decisions. This section is entirely optional.
Use more paper if needed.
1. Please describe your farm or business operation, its history and your plans for its future?
2. How many miles is your farm from the downtown Farmers Market?
3. What percentage of your income is generated by your farm / business enterprise?
4. What percentage of your production do you sell at the Lane County Farmers Markets?
Is this increasing or decreasing?
Increasing Decreasing
5. What have you found to be the best marketing strategies for success at Farmers Markets?
6. How can the Lane County Farmers Market better serve you?
7. What long-term vision or goals would you like to see the LCFM pursue?
INSURANCE

LCFM insurance coverage no longer extends to its members. The Market requires that you
carry your own liability insurance.
Please indicate the agency with which your farm or business operation has its own liability insurance. *
ANNUAL MEMBERSHIP FEE $35.00
Please enclose a $35.00 annual membership fee payment with the return of your application.
Thank you. *
Cash Check
Provide check #
2009 LANE COUNTY FARMERS MARKET MEMBERSHIP AGREEMENT

The undersigned member agrees to exercise the utmost care in the use of the facilities and properties of Lane County, the City of Eugene and the Lane County Farmers Market. The member also agrees to in- demnify and hold harmless Lane County, the City of Eugene and the Lane County Farmers Market, its Board of Directors, officers, employees, and agents from any and all claims, actions, judgments, losses, costs (including reasonable attorney fees), and damages whatsoever, including claims arising by reason of accident, injury, or death caused to persons or property of any kind, arising out of, in connection with, or incident to, the Lane County Farmers Market, except caused by the sole negligence of Lane County, the City of Eugene or the Lane County Farmers Market.
I/WE HAVE READ & AGREE TO ABIDE BY THE 2010 LCFM HANDBOOK WITH RULES & GUIDE-LINES, & UNDERSTAND THAT ANY VIOLATIONS OF THESE OR ANY FEDERAL, STATE, OR LOCAL RULES MAY RESULT IN THE REVOCATION OF THIS AGREEMENT & EXPULSION FROM THE MARKET

By typing your name below and submitting this form you agree to all terms of LCFM Membership Agreement *
Date * MM / DD / YYYY
Do Not Fill This Out

Wufoo

Where appropriate:

PRODUCT LABELING

PRODUCT CLASSIFICATION

I. GROWN BY MEMBER

II. GROWN OR PROCESSED BY MEMBER

III. GROWN BY MEMBER AND CRAFTED/PRODUCED

IV. COLLECTED/WILD-CRAFTED STRICTLY REGULATED

V. FOODS PREPARED BY MEMBER

VI. CRAFTED BY MEMBER

MARKET PARTICIPATION

Which dates do you expect to start and end your season?

MEMBER PROFILE

INSURANCE

2009 LANE COUNTY FARMERS MARKET MEMBERSHIP AGREEMENT