LAILG ENROLLMENT FORM
Business Name
*
Owner's First name
*
Whose name should be listed on the invoice?
Owner's Last Name
Whose name should be listed on the invoice?
Owner's Email
example@example.com
Business Phone Number
*
Please enter a valid phone number.
Is there another contact person for the company?
*
Yes
No
Contact's First name
*
Contact's Last Name
*
Contact's Email
example@example.com
Contact's Phone Number
Please enter a valid phone number.
For additional contacts, please list their name, email and phone number below.
Mailing Address
Street Address
*
Street Address
City
*
City
State
*
Zip Code
*
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General Operational Questions
Please answer the following questions for your company as a whole (including sites outside of LA County or California).
1. What is your primary crop?
*
Nursery Stock
Greenhouse
Row Crops
Orchard
Vineyard
Other
1a. Please list the different crops grown at this site in the last 12 months:
*
CROP TYPE
GO
GH
C
F
O
R
V
M
S
IP
2. What is your company's gross annual sales?
*
Up to $50,000
$50,001-$199,999
$200,000,$349,999
$350,000-$500,000
$500,001-$1,000,000
$1,000,001-$1,999,999
$2,000,000-$5,000,000
Over $5,000,000
PCA Dues
3. How many total irrigated acres do you operate throughout ALL operations in the United States?
*
Less than 5 acres
Between 5-9.9 acres
Between 10-24.9 acres
Between 25-99.9 acres
100 or more acres
4. Does your company operate more than one agricultural facility in the United States?
*
Yes
No
5. Do you move material between facilities?
*
Yes
No
6. Do you ship out of state?
*
Yes
No
7. Do you ship material (either sales or intracompany transfer north of Santa Barbara?
*
Yes
No
Grouping Score
Group Placement
GROUP
Micro
Unknown
Large
Medium
Small
SAMPLING REGION
N
S
8. In what language would you prefer to receive communication from LAILG?
*
English
Spanish
Both
Other (Please list here)
9. How would you like to receive your annual invoice?
*
Email
Hardcopy via USPS
Both
Other (Please list here)
10. Would you rather attend a continuing education meeting:
*
In person
Via webinar
No preference
11. In what language would you prefer continuing education meetings be taught?
*
English
Spanish
Both
Other
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Agricultural Operation Site Specific Questions
If you operate more than one site in LA County, you will be redirected to complete this section for additional sites.
Individual Company
x
LAILG Membership Number
Leave blank if this is a new enrollment
Is the address for this site the same as the mailing address?
*
Yes
No
Site Address
If the site address is different, please list the address or cross streets
Street Address
Street Address
City
City
State
Zip Code
OWNER
Please list all parcel numbers (APN) for this site. Separate multiple APN numbers with a comma. (ex. 1234-567-890, 2345-678-901).
*
To look up parcel numbers, please visit: https://maps.assessor.lacounty.gov/m/
Who owns the parcel of land you operate?
*
LA DWP
SCE (Southern California Edison)
Privately Owned
Parcel Owner Information
WATERSHED
LA
SG
D
IP
SC
SM
Total Site Acreage
*
Total acreage of your site.
Irrigated Acreage
*
Only include the acreage that is irrigated.
BILLING IRRIGATED ACREAGE
Enrollment Form
No
Yes
X
2023-24 CEU
n/a
null
2023-24 DUES
X
IP
n/a
null
2023-24 Dues
X
IP
n/a
null
NOTES
Salutation
Mr.
Ms.
Mrs.
Span_Salutation
Estimado Sr.
Estimada Sra.
First Name
Last Name
Language
Bilingual
English
Spanish
Do you operate more than one agricultural site in Los Angeles County?
*
Yes
No
Managed Acct.
Coastal PM
Paul Warson
Scott Bucy
Billing Status
Mixed
Hold
BMP Form
Yes
No
IP
Other
2024-25 Billing Complete
Yes
No
2024-25 Dues
Yes
No
Payments
Sales < $2M
Yes
No
PCA
Cell Phone
Please enter a valid phone number.
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