Full Membership Form

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

1) Name:
2) Date:
3) Name of Firm:
4) Phone Number:
5) Address:
6) Educational Information:

7) Area of Specialization:

8) List Colleges, Dates, Degrees, And Specialization:
A:
B:
C:

List licensed consultant worked with and give contact information.
Name:
Address:
Phone:

9) How Many Years Have You Been In Agricultural Consulting?
# of Years:

10) In What Area of The State Do You Work?
Area:

11) Are You Currently Certified?

12) If So Give Card Number:
Card #:

13) List Categories Certified In:
A:
B:
C:

14) List Two References For Which You Have Served As A Consultant And Include Address:
Reference 1:
Address:
Phone:
Reference 2:
Address:
Phone:

15) LACA Voting Member Reference:
 
Any Additional Information:
I do certify that I am a certified agricultural consultant working directly for the farmer and receiving a fee for my services. I also certify that I do not sell or contract anything what would constitute a conflict of interest with the business of a private agricultural consultant. I also give my permission for L.A.C.A. to contact the above references to verify my consulting activities.

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