Harvest 365 Benefit Choices

Thank you again for your dedication to making sure hungry families, children and seniors have access to food with your Harvest 365 membership. To show our appreciation, we would love to send you a small gift to help you GIVE VOICE in the fight against hunger.

"*" indicates required fields

Name*

First Last

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

Phone

Email*

Would you like a free reusable tote bag to help you GIVE VOICE in the fight against hunger?

Yes

No

Would you like us to send you 12 envelopes to mail your personal checks in each month?

Yes

No

Would you be interested in taking a tour at Harvesters?

Yes

No

Benefit Choice ($25/month minimum)*

Lunch Bag

T-Shirt

T-Shirt Size

Small

Medium

Large

Extra Large

Comments or Questions

Questions or concerns? Please contact Cindy Ptacek at cptacek@harvesters.org or (816) 929-3037.