Lnla Membership Application

2017 LNLA MEMBERSHIP APPLICATION

NOTE: ALL “Regular”, “Out-of-State Associate” & “Affiliate Members” Should Also Indicate Business Type in Box at Right. (For Affiliate Memberships, at least one person of the business must be a Regular or Associate Member)

☐REGULAR MEMBER (Voting) - $ Based on gross sales per year (below) A licensed or permitted Louisiana business or person engaged in one or more of the business types listed in box at right -- Please select no more than 5. Dues Annual Gross Sales ☐$100.00 $0 - $249,999 ☐$150.00 $250,000 or more

☐ASSOCIATE MEMBER (Non-Voting) - $150.00 – includes all out-of-state businesses ☐Associate Louisiana Member – A Louisiana business or person not directly selling or servicing plants (eg. Sell/Service chemicals, containers, equipment, fertilizer, garden décor, outdoor furniture, insurance, mulch, soil, stepping stones, etc.) Products or Services sold: ______

☐Associate Out-of-State Member -- State: ____ Please select no more than 5.

☐AFFILIATE MEMBER (Non-Voting) – $25.00 An employee (not owner) of a Regular or Associate Member business type listed in box to the right -- Please select no more than 5.

☐GOVERNMENT/EDUCATION MEMBER (Non-Voting) – $25.00 An employee of a government or non-profit entity, having a job responsibility in horticulture or closely related field ☐College or University Education/Extension/Research (U) ☐Educational/Regulatory Government Agency (GV) ☐Public Gardens or Parks (PG)

☐RETIREE MEMBER (Non-Voting) (R) – $25.00 Any person formerly actively employed in horticulture or closely related field and having been a paid member of LNLA before retirement from that employment.

☐STUDENT MEMBER (Non-Voting) (S) Full time student enrolled in a Louisiana university/college in horticulture or a closely related field. University/College name & location (city): ______☐$0 Free – Receive Newsletter by email only ☐$25.00 – Receive Newsletter by mail

PLEASE INDICATE PREFERENCE FOR RECEIVING LNLA QUARTERLY NEWSLETTERS:

☐Email only (default) ☐U. S. Mail only ☐Both email and U. S. Mail

□ OPTIONAL: If you wish to support the Louisiana Nursery & Landscape Foundation for Scholarship & Research (LNLFSR) fund for scholarships to deserving university/college horticulture/landscape students and grants for horticulture/landscape research/education should indicate amount and add the $$ to their dues check. LNLA will forward the donation. LNLFSR Donation Amount $______Make check payable to: Louisiana Nursery & Landscape Association Mail check and entire form to: LNLA, 126 Bertel Drive, Covington, LA 70433

PLEASE PRINT CONTACT INFORMATION CLEARLY Your Name:

Business/Organization:

Mailing Address:

City: State: Zipcode:

Phone1: Phone2: Tollfree:

FAX1: Email: Website:

Referred by (Name, Business Name, City, State): ______

Please allow 4-6 weeks for new membership processing & delivery of materials. Rev. 6-5-17