Re-enrollment form 2016

Download the GVG 2015 Re-enrollment form

GVG 2015 Re-enrollment Agreement

 

Name :______________________________ Date:___________

 

GREENBRIER VALLEY GROWN CERTIFICATION AND LICENSE AGREEMENT

The GVG logo was developed to certify food and agricultural products grown or raised by locally operated farms in the Greenbrier Valley region of West Virginia.  Individuals and organizations who agree to comply with the terms and conditions in this Agreement are authorized to use the GVG logo and related materials in a manner that complies with GVG standards.

Exceptions to any of the criteria will be considered on a case by case basis.  

 

This License Agreement is entered into by and between GVG and the food business listed below (LICENSEE). Agreements are valid for the current calendar year and must be renewed annually. If signed after October 1, the certification agreement is valid for the remainder of the current calendar year and the entire following calendar year.  ______________________ (NAME OF BUSINESS) herein referred to as LICENSEE desires to make use of the GVG logo and promotional materials. Effective on the subscribed date, the LICENSEE agrees to the following terms and conditions.

 

q     I have seen a copy of the Terms and Conditions and I Agree to follow them

q     I DO NOT agree to follow the Terms and Conditions

 

_______ (initial here) I consent to Greenbrier Valley Grown and its representatives to source and use any pre-published photos or video of my GVG-certified food business for the purposes of marketing and social media.

    I consent for GVG to publish the following food business information to the GVG website for marketing purposes:    ____Email   ____Website   ____Business Facebook   ____Telephone Number

As a participant I understand the purpose of the GVG program is to promote the meaningful inclusion of place based local foods as an economic practice in the Greenbrier Valley region. I pledge to use the logo and all other promotional materials in a manner consistent with the intent of the GVG program.

 

 

____________________________________        _____________

By (Authorized Signature)                                                      Date

 

$25 re-enrollment fee is requested       o Cash     o Check

 

q     My information has stayed the same

q     My information has changed, see below

 

___________________________________________________________________

Name & Title of Person Signing (Please Print)

 

___________________________________________________________________

Business Name (Please Print)

 

___________________________________________________________________

Street Address, City, State, Zip

 

________________        ________________________________________________

County/Counties                 Farms Only: 1. Total Acres Farmed      2. Products Produced

 

___________________________________________________________________

Phone                                Fax                Email

 

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