Join 2023 "*" indicates required fields Join at the recurring annual donation level of...*New Agrarian level - $36Steward level - $60Range level - $180Watershed level - $240Horizon level - $600***We are having some trouble with our form - please ignore the added math in the membership options. Each level will cost as advertised on our membership page. Memberships are automatically recurring. This means you don't have to worry about renewing! Your donation will be annually charged to the card you provide unless you select a monthly payment plan below. If you want to make a custom, one-year membership that does not automatically recur, please pay by check or contact Sam Hinkle at sam@quiviracoalition.org.This field is hidden when viewing the formUntitledI would like to pay monthly ($3/month) New Agrarian Monthly Subscription I would like to pay monthly ($5/month) Steward Monthly Subscription I would like to pay monthly ($15/month) Range Monthly Subscription I would like to pay monthly ($20/month) Watershed Monthly Subscription I would like to pay monthly ($50/month) Horizon Monthly Subscription Add a one-time donation to my membership Member infoFirst Name*Last Name*Organization NameEmail* PhoneAddress* Address City StateAlabamaAlaskaAmerican 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 State Zip Code CommentsBirth monthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberSo we can wish you a happy birthday!Membership CalculationTotal I would like to pay by Credit Card Check Credit CardCard Details Cardholder Name Would you like to receive exciting, regenerative content from Quivira? Subscribe to E-News Subscribe to our podcasts Select AllThis field is hidden when viewing the formUnique IDDid someone refer you to Quivira?If so, please include their email address here. They may get a free REGENERATE ticket! We will not solicit or send newsletters to this address unless it is already in our mailing list. This field is hidden when viewing the formProgramThis field is hidden when viewing the formGrantorThis field is hidden when viewing the formGrantThis field is hidden when viewing the formUntitled First Choice Second Choice Third Choice PhoneThis field is for validation purposes and should be left unchanged. Δ
