POCD Intake Form

First Name

Last Name

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Phone

Phone (Alternative)

E-Mail

Preferred method of contact

Farm or Business Name, if Applicable

How did you hear about Pend Oreille CD?

Would you like to receive email newsletters from POCD? (Check the box below.)

Yes

Are you interested in volunteering with POCD? (Check the box below.)

Yes

Is the property address different from the mailing address above? (Check the box below if so.)

Yes

Does your property have frontage on the Pend Oreille River? (Check box below.)

Yes

Do you know the parcel number(s) for your property? (Providing this information would help POCD planners look up your property using publicly available data from Pend Oreille County.)

Do you know which large watershed your property is in? You can find more information about WRIAs linked on the right.

Do you know which smaller watershed your property is in (i.e. the name of a creek that runs through the property)?

Project Location Where are you interested in getting assistance? (This could be a street address, or a general location description such as "River Mile 200 of the Pend Oreille River".)

What conservation practices do you currently do on your property? (Select as many as apply.)

Goals/Interests: (Select as many as apply.)

Other Goals and Interests

Are you interested in receiving cost-share assistance from POCD? (If so, check box.)

Yes

I am interested in the following program(s)--check all that apply

If other programs:

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