|
Federation of
Southern Cooperatives |
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| SEE MEMBERSHIP LIST |
| Federation of Southern
Cooperatives/Land Assistance Fund Individual Membership Application |
| Name__________________________________________________________
Address________________________________________________________ City______________________________State______________Zip________ Phone_________________________________________________________ Date__________________________________________________________ • Are you a member of a co-op, credit union? Yes_____ No_____ If yes, which one?_______________________________________________ • Are you a family farmer and/or land owner? Yes_____ No_____ • How many acres of land do you own? Acres_____________ • Are you having any land related problems for which you need assistance? Yes_____ No_____ If yes, brief description.____________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ I am paying $25 now_______ Please bill me______ |
| Please mail your application to: |
| Federation of Southern Cooperatives Land Assistance Fund 2769 Church Street East Point, GA 30344 |
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