Louisiana Irrigation Association

HOME	Fill out and send to the following address: Louisiana Irrigation Association 444 Fox Trot Drive Mansfield, Louisiana 71052 Download pdf format application
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LIA MEMBERSHIP APPLICATION

Louisiana Irrigation Association

444 Fox Trot Drive

Mansfield, Louisiana 71052

Type of Membership / Dues:

Regular [Contractor / Technical] $100.00

Associate [Distributor / Rep.] $300.00

Employee of Member [non-voting] $ 25.00

Student or Faculty [non-voting] $ 25.00

___________________________________ ______________________________________

Name Business / School

___________________________________ ______________________________________

Home Address Business / School Address

__________________________________________ _____________________________________________

City State Zip City State Zip

_____________________ _________________ ________________ ______________

e-mail address Home Phone Business Phone FAX

Are you or your company an IA member? Yes No

Primary Focus: Agriculture Golf Landscape / Turf

Do you have any Irrigation Certification? Yes No

If so, which? _______________________________________________________________

_________________________________________ ____________________

Signature Date

Please send this completed form with the appropriate dues to LIA at above address!

Last modified: 12/05/07