Program Fee

Please use the form below to pay your Program Fee with a credit card.

Checks can be mailed to: Red Wiggler Community Farm P.O. Box 968, Clarksburg, MD 20871

You are completing this form on behalf of someone else. Please enter their details.

Other Amount/Additional Donation

Basic Tour - $ 75.00

Sensory Exploration Tour - $ 75.00

2-3 Hour Service Visit - $ 50.00

Corporate Volunteer Visit - $ 250.00

Consultation - $ 200.00

Alternative Spring Break - $ 50.00

Other Amount

Other Amount $

Total Amount

Email Address *

I am making a payment on behalf of an organization.

On Behalf Of Organization

Organization Name *

Phone (Main) *

Email (Main) *

Street Address *

City *

Postal Code *

Country *

State / Province *

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *