CROP IMPROVEMENT ASSOCIATION FOR MCIA OFFICE USE ONLY APPLICANT Check No. Amount Member No. Check No. Amount Name If other than Applicant: Address Paid by City, State, Zip Member No. County FEES (See Fee Schedule) Membership --- Fields --- Acres --- Late Fee SEND PAYMENT WITH APPLICATION _______ _______ Acreage Fee CREDIT APPLIED $ Late Application Fee AMOUNT OWED ON PREVIOUS BILL $ Membership Fee Payment for Previous Bill PAYING FOR FOLLOWING GROWER(S): MEMBER NO. TOTAL SUBMITTED TO MCIA NAME AMOUNT PAID $ 2) MEMBER NO. FEES NAME See Fee Schedule for the applicable program. You may include fees for multiple applications on one AMOUNT PAID $ form. AMOUNT APPLIED TO Fee schedules available from Minnesota Crop THIS APPLICATION $ Improvement Association. SEND PAYMENT WITH APPLICATION Make checks payable to Crop Improvement Association
CROP IMPROVEMENT ASSOCIATION APPLICANT Member No. Name Address City, State, Zip County FOR MCIA OFFICE USE ONLY Check No. Amount Check No. Amount If other than Applicant: Paid by Member No. FEES (See Fee Schedule) SEND PAYMENT WITH APPLICATION Membership --- Fields --- Acres --- Late Fee _______ _______ CREDIT APPLIED $ AMOUNT OWED ON PREVIOUS BILL $ PAYING FOR FOLLOWING GROWER(S): MEMBER NO. NAME AMOUNT PAID $ Acreage Fee Late Application Fee Membership Fee Payment for Previous Bill TOTAL SUBMITTED TO MCIA FEES See Fee Schedule for the applicable program. You may include fees for multiple applications on one form. Fee schedules available from Minnesota Crop Improvement Association. SEND PAYMENT WITH APPLICATION Make checks payable to Crop Improvement Association 2) MEMBER NO. NAME AMOUNT PAID $ AMOUNT APPLIED TO THIS APPLICATION $