Form Center

2. First Name
3. Last Name
5. Email*
7. Phone
9. Address1
11. Address2
13. City
14. State
15. Zip
17. Please select all that apply:*

    1. I would like a 4' X 8' raised bed at the cost of $65 per growing season
    2. I would like to help create another community garden in Cocoa Beach
    3. I can help build raised garden beds
    4. I can help secure grants, sponsors and other financial resources to improve the community garden

19. Once submitted, your application will be reviewed and you will be contacted by the administrator when a garden space is available. Please be advised that the community garden has a limited number of beds available that are assigned on a first come first serve basis for each growing season. If there are no available spaces, applicants are placed on the waiting list in the order that their application was received. 

21. Need additional information?
    Submit questions here.
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field