Interest Form

Complete on screen and fax to 225-578-4443 or submit electronically.

I am (or my organization/company is) interested in:

scheduling a presentation with my organization's/company's leadership.

becoming a Key Contributor by supporting the project with:

	a donation of funds to the Louisiana House
	a donation of materials, equipment, supplies or labor (specify: )

becoming a Key Partner through a grant or contract agreement with the LSU AgCenter
becoming a Key Ally through an agreement to work with the LSU AgCenter
(specify program area(s): )

promoting the project or helping to recruit other partners and supporters

other:

Prefix:

(ex. Mr., Mrs., Dr.)

First Name:

Last Name:

Suffix:

(ex. III, Jr., Sr.)

Position:

Institution:

Address:

City:

State:

Zip-Code:

E-mail:

Phone#:

-- ext.

Fax#:

Category:

Please characterize your institution, if you are not submitting this form as an individual.

Comments

Please print for your records before hitting the "Submit" button.


� Copyright 2001 LSU AgCenter All Rights Reserved \| Privacy \| Disclaimer \| EEO \| Search \| Subjects \| LSU \| Contact Us \|	Best viewed in MS Internet Explorer: