Affiliate or Associate Membership Form

The membership application review process will take place between October 1 and April 30.

1) Date:
2) I Nominate:
3) For:
4) Address of Nominee:
5) City:
6) State:
7) Phone Number:
8) If Student: University(ies) Attended
Major:
Career Plans:
If Field Scout: Employed by:
Employer Contact Info.:
Other Employer:
Employer Contact Info.:
Years in Current Profession:
Contributions to Louisiana Agriculture:
Years Attending LACA Annual Meeting (Louisiana Agricultural Technology & Management Conference):
9) Person Making Nomination:
Your Name:
10) Address:
11) Phone Number:

Any Additional Information: