The Land Trust Alliance: Land Trust Membership Form

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Land Trust Membership Form

Please send this form, along with a copy of your organization's 501(c)(3), 509(a)(3) or municipal /township status to:

Land Trust Alliance
1660 L St. NW, Suite 1100
Washington, D.C. 20036

202-638-4730 (fax)

Questions: Contact the Membership Coordinator at: membership@lta.org, or:(202)-638-4725 ext.331.

Contact Information

Land trust

Contact Name

Title

Address

City State Zip

Phone Fax

Email Website URL

Dues

Our organization's operating expenses last year totaled: ,
therefore, our dues are . (See chart below.)

If last year's operating expenses were:	Member dues are:
$10,000 or under	$ 225
$10,000 to $30,000	$ 325
$30,001 to $50,000	$ 550
$50,001 to $70,000	$ 750
$70,001 to $100,000	$ 950
$100,001 to $250,000	$1,175
$250,001 to $1,000,000	$1,400
$1,000,001 to $3,000,000	$1,750
More than $3,000,000	$2,500

Exchange Subscriptions

Please distribute our three free subscriptions to Exchange as follows:

Number of copies to billing address
Number of copies to other addresses (Please attach address list.)

*Land Trust Standards and Practices*
	Our land trust has adopted the Revised Land Trust Standards and Practices and I am enclosing a copy of the board resolution*.
	Our land trust has not yet adopted* the Revised Land Trust Standards and Practices, but we will and then will send you a copy within one month of joining.
	Please send additional information about the Revised Land Trust Standards and Practices.
Please note: New Members have one month to adopt Land Trust Standards and Practices. * A sample board resolution is available for review and download.
Payment Information
	Check enclosed. Please make checks payable to the Land Trust Alliance.
	OR
	Credit Card (choose one) MasterCard Visa

Thank you for your membership!