Membership Application ⇽ Individual Membership

Uploading an image is mandatory

Please enter a first name

If you input more than 0 characters your First Name may not display properly

Please enter a last name

If you input more than 0 characters your Last Name may not display properly

Please enter a valid email address
e.g. john.doe@glueup.com

If you input more than 0 characters your Email Address may not display properly

・8 characters minimum
・one upper case letter
・one lower case letter
・one number
・one special character (@$!%*?&)

If you input more than 0 characters your Password may not display properly

・8 characters minimum
・one upper case letter
・one lower case letter
・one number
・one special character (@$!%*?&)

If you input more than 0 characters your Confirm password (at least 8 characters) may not display properly

Please enter a first name

If you input more than 0 characters your First Name may not display properly

Please enter a last name

If you input more than 0 characters your Last Name may not display properly

Please enter a valid email address
e.g. john.doe@glueup.com

If you input more than 0 characters your Email may not display properly

Please enter a valid phone number including country code

If you input more than 0 characters your Phone may not display properly

If you input more than 0 characters your Preferred Name (If you prefer we call you something other than the name you listed above, let us know! This may include a prefix like Ms., Mr., Sister, or Brother. It can also be a nickname.) may not display properly

Please enter a what are your pronouns? (examples: she/her/hers, they/them/theirs, he/him/his. find out why we ask by visiting mypronouns.org)

If you input more than 0 characters your What are your pronouns? (Examples: she/her/hers, they/them/theirs, he/him/his. Find out why we ask by visiting MyPronouns.org) may not display properly

Please enter a address

If you input more than 0 characters your Address may not display properly

If you input more than 0 characters your City may not display properly

Please enter a state/province

If you input more than 0 characters your State/Province may not display properly

Please Select Valid Province Value

Please enter a postal code/zip code

If you input more than 0 characters your Postal Code/Zip Code may not display properly

Please select an option

Select one or more options

Please select an option

Please enter a why do you support bfu-nys's solutions? (tell us why our solutions matter to you and your work.)

If you input more than 0 characters your Why do you support BFU-NYS's Solutions? (Tell us why our solutions matter to you and your work.) may not display properly

Please enter a if you have worked with one or more existing bfu-nys members, please tell us more about your relationship to them. (write "n/a" if not applicable.)

If you input more than 0 characters your If you have worked with one or more existing BFU-NYS members, please tell us more about your relationship to them. (Write "N/A" if not applicable.) may not display properly

Please enter a what are your current connections to food and farming? are you connected to any food and farming communities in new york state?

If you input more than 0 characters your What are your current connections to food and farming? Are you connected to any food and farming communities in New York State? may not display properly

Please select an option

Select one or more options

If you input more than 0 characters your Please share anything else that you would like us to know. may not display properly

This checkbox is mandatory

If you input more than 0 characters your Email Address may not display properly

If you input more than 0 characters your Phone may not display properly

If you input more than 0 characters your Password may not display properly

・8 characters minimum
・one upper case letter
・one lower case letter
・one number
・one special character (@$!%*?&)

If you input more than 0 characters your New Password may not display properly

Please make sure this password matches the password above

If you input more than 0 characters your New Password may not display properly

・8 characters minimum
・one upper case letter
・one lower case letter
・one number
・one special character (@$!%*?&)

If you input more than 0 characters your New Password may not display properly

Please make sure this password matches the password above

If you input more than 0 characters your New Password may not display properly

Glue Up account creation information.

Please fill in your member application details.

Glue Up account creation information.

Please fill in your member application details.

Consent