To provide necessary capital for the proposed retail food co-op, The Assabet Village Food Cooperative, Inc. (d.b.a. Assabet Village Co-op Market), and to acquire a membership in the Cooperative, I agree to purchase one (1) share at a price of $200.

Owner Name *

Owner Address *

Main Phone *

Email Address *

I authorize the following individuals from my household to shop with my Owner card. Their purchases will count towards determining my Patronage Rebate. They will not have voting rights. (Please enter one name (first and last) per line)

How did you hear about the Co-op?

I give permission for the cooperative to list my name and town as an Owner in promotional material, including on Facebook and on their website. *

The cooperative may send official correspondence to me electronically. *

I want to learn more about how I can help. Please contact me about volunteering.


Please Read and Sign below:
1. Only those Members who have paid in full will have voting rights and access to the Patronage Rebate program.
2. Membership and the rights of Membership are subject to the By-laws of the Cooperative, as they may be amended from time to time. I agree to be bound by such By-laws. I may access an up-to-date copy of the By-laws at and may also receive a paper copy on request.
3. Member shares are not transferable. While Member equity is refundable, it is at the discretion of the Board of Directors.
4. I understand that, as with any start-up enterprise, Member equity is subject to risk, including the risk of loss. Member equity is subordinate to all other debts of the Cooperative.


Please sign by entering your name below (I am 18 years or older): *

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