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SCFF Membership Application(3)
Restaurant/ Caterer/ Accommodator / Educator / Micro-processor New/Renewal Application Form
Name - Primary Contact
First
Last
Name of Business/Organization
Type of Operation - Please indicate which category applies to your operation
Restaurant / Caterer
Accommodator
Micro-processor
Educator / School
Other
Other (please specify)
Address - please note this information may be published on our website and the Local Food Map
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Location address - if different from the above contact/mailing address. please note this information may be published on our website and the Local Food Map
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Please provide detailed verbal directions to your Business/Organization. (i.e. 1 km north of Hwy. 400 on Hwy 93)
Phone
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Email - this information will be published on our website and Local Food Map
Alternate email - for internal use only
Web Site
Facebook Page
Twitter Handle
Instagram
Business/Market Information for printed map and website listings: List food/beverage products (for human consumption).
Simcoe County Farm Fresh reserves the right to edit submissions and choose what information will be published.
Simcoe County Farm Fresh is not responsible for any errors or omissions.
Please indicate (check all that apply)
Wheelchair Accessible
Able to accept bus tours
Public Washrooms
Call ahead only
Business Hours (including Months, Days and Time)
Please include a list of sources (farms/producers) of Simcoe County Farm product you use or sell in your products / business. See below for list of Qualifications.
Please write a one sentence tag line for the website listing. This can be used to highlight a special event or product. (i.e. “Season Opening Special” or “Join us for our annual Blueberry Festival!”)
Special events (if you would like your special event for 2016 mentioned in the “Upcoming Events” section on the www.simcoecountyfarmfresh.ca website please indicate what, where, and when.
Questions to determine qualifications of Member Group (Restaurant/ Caterer/ Hotel / Resort / Educator / School/ Micro-processor) Please note: Members in this category must be able to produce evidence that they are meeting the qualifying criteria, if requested, by the association. Members are encouraged to source from other members of the association where possible.
Yes
No
Is your business located within Simcoe County? (If located outside of the County, acceptance of membership will be at the discretion of the Board of Directors)
Are you committed to sourcing and serving local food?
Do you source from a minimum of Four (4) Simcoe County producers/farms OR a minimum (10) Ten products that are actively sourced throughout the year? (Names of sources and products must be listed above)
Do you demonstrate your commitment to sourcing and selling local food/beverage to your customers by: Listing your farm partners on your web site, on your menus, within your establishment? Training your staff? Educating your customers?
Will you be an active and engaged member of Simcoe County Farm Fresh Marketing Assoc.?
Will you act as a champion of local food/beverage in your community?
Membership Fees
Restaurant/Caterer/Accommodator/Educator/Micro-processor Membership - $195.00 + HST = 220.35
Additional Listing - $100.00 each + HST = 113.00
Please indicate if you DO NOT want to be included in the 2016 printed version of the Local Food Guide Map
No, I do not wish to be included in the printed version of the Local Food Guide Map
Please indicate Method of Payment - Note: Payment MUST be received by March 1, 2016 in order to receive a listing in the 2016 Local Food Guide Map (printed version) Please note, if you select Credit Card, you will be emailed an invoice which you can pay directly from
Visa
Mastercard
E-transfer - send to scfarmfresh@gmail.com
Cheque - make payable to Simcoe County Farm Fresh
I (please print your name)
certify and accept responsibility for ensuring the above information is correct and will be adhered to. I agree to the minimum standards / code of ethics and responsibilities as stated. I also give permission for my personal information listed above to be used for the purpose of publishing a directory of Simcoe County Farm Fresh members.
This Simcoe County Farm Fresh Membership is valid between March 1, 2016 & February 28, 2017. Membership eligibility, criteria, fees and benefits will be reviewed and may be modified annually. (Please sign below - type your name if you do not have an electronic signature)
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