Code of Hammurabi, c. 1780 BC

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West Virginia Farm Bureau Membership Application Member name (First name, middle initial, last name, suffix):
__________________________________________________________________________________________
Spouse (First name, middle initial, last name, suffix):
__________________________________________________________________________________________ *if using membership for discount on Nationwide Insurance products, please list name of policyholder under member name
Address:_________________________________________________________ Make checks payable to the
county Farm Bureau you
are joining. Mail completed
application with check to:
West Virginia Farm Bureau
1 Red Rock Road
Buckhannon, WV 26201

Questions? Call
800-398-4630 ext. 300
________________________________________________________________

Telephone:_______________________________________________________

E-mail:__________________________________________________________

What county Farm Bureau do you wish to join?___________________________

Name of person/agency who explained Farm Bureau membership benefits to
you:_____________________________________________________________ *Please include Nationwide agency # if applicable Check one: □ This is the first time I have joined Farm Bureau. □ I am renewing my membership or rejoining Farm Bureau. I am/was a member in ________________ County. My membership number is/was__________________ Check one: I will be joining as a: □ Farmer member (see definition below) □ Non-farmer member “FARMER MEMBER” shall mean anyone who is an owner, retired previous owner, operator or anyone who has a financial interest in a farm,
whether cropland, pasture, or woodland, including ornamental horticulture and greenhouses. The financial interest may be as a resident or
non-resident owner, a partner, a stockholder in an incorporated farm, a tenant, a farm manager, or an employee. The size of the farm, amount
of income from the farm, or percentage of the member’s total income derived from the farm or other employment of the member will not be a
factor in determining if the member is a “farmer member”, except that a lot only large enough for a house and garden will not be considered a
farm.
Check two: (to be answered by Farmer member applicants only) Type(s) of agricultural product(s) produced in your operation: □ Beef □ Dairy □ Poultry □ Tobacco □ Sheep □ Fruits & Berries □ Equine □ Other: __________ County Farm Bureau Dues (see listing below) $__________ Voluntary contribution to Farm PAC (suggested) $ 2.00 (Corporate contributions to a PAC prohibited by law) Total amount enclosed: $__________ Note: Contributions, gifts, or membership dues are not deductible as a charitable contribution for Federal Income Tax
purposes. Please consult your tax professional regarding possible deductibility as a business expense. COUNTY FARM BUREAU DUES:
*indicates non-PAC county BARBOUR* $45.00 GREENBRIER $40.00 MARION $40.00 PENDLETON $42.00 TAYLOR* $40.00 BERKELEY $45.00 HAMPSHIRE $40.00 MARSHALL $43.00 PLEASANTS $37.00 TUCKER $38.00 BRAXTON $39.00 HANCOCK $40.00 MASON $43.00 POCAHONTAS $40.00 TYLER $40.00 CABELL $42.00 HARDY $40.00 MERCER $41.00 PRESTON $38.00 UPSHUR $43.00 CALHOUN* $38.00 HARRISON $45.00 MINERAL $40.00 PUTNAM $45.00 WAYNE* $42.00 CLAY $45.00 JACKSON $38.00 MONONGALIA $40.00 RALEIGH* $40.00 WEBSTER $34.00 DODDRIDGE $40.00 JEFFERSON $40.00 MONROE $38.00 RANDOLPH $45.00 WETZEL $43.00 FAYETTE $40.00 KANAWHA $45.00 MORGAN $45.00 RITCHIE $40.00 WIRT* $40.00 GILMER $40.00 LEWIS $40.00 NICHOLAS $42.00 ROANE $40.00 WOOD $40.00 GRANT $40.00 LINCOLN* $44.00 OHIO-BROOKE $36.00 SUMMERS $41.00
Please read and sign: I understand that I am applying for membership into the county Farm Bureau listed above and that once accepted, which occurs at the time a membership number is assigned to me, my membership is valid for twelve months and that my payment for dues is
non-refundable.

_________________________________________________________________/_______________________
Signature Date

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