Member Information Form

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Name of Land Trust*
Year Created / Formed*
Number of Fee Title Acres Protected
Number of Conservation Easement Acres Protected
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Website
Social Media Link (ie Twitter, Facebook, other)
Please list the counties you focus on (or indicate “statewide” if applicable)*
Mission Statement*
Upload Logo*
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Upload Photo*
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Photo Credit
Name
This field is for validation purposes and should be left unchanged.