Step #1: Organizational Information Sheet
Email address *
Our organization is applying as: *
Membership Dues:
$100.00 if agency annual revenue exceeds $250,000, $50.00 if revenue is below $250,000.

Make all checks payable to: LA Regional Food Bank - ENLA Account

Mailing Address:
Emergency Network Los Angeles
Attn: Nathan Wolfstein
19040 Vanowen Street,
Reseda, CA 91335

Annual Revenue: *
Amount Enclosed: ($)
Your answer
General Information
Legal Name of Organization/Business: *
Your answer
Address:
Your answer
Website:
Your answer
Phone:
Your answer
Fax:
Your answer
ENLA Liaisons
Name of Executive Director/Senior Clergy: *
Your answer
Primary Liaison to ENLA: *
Your answer
Liaison Phone: *
Your answer
Liaison E-mail: *
Your answer
Liaison Fax:
Your answer
Secondary Contact:
Your answer
Secondary Phone:
Your answer
Coverage Areas
We are located in Disaster Management Area (DMA) *
Required
Services Provided/Available
Select 3 of the below service classes
Service classes corresponding to your agency *
Required
ENLA Committees
Select the below committees you (and your agency) are interested in joining
Committee groups to join
Is your organization interested in hosting an upcoming meeting?
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