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Do You Work, Live, or Own a Parcel of Land land near the Chiquita Canyon or Sunshine Canyon Landfills?

Work Live Live / Not Working Own a Parcel of Land

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Primary Contact

First Name *

Last Name *

Primary Contact Birth Date *

Primary Contact Email *

Primary Contact Home Phone

Primary Contact Mobile Phone *

Including yourself the number of family members over the age of 18 living in the household *

The number of family members under the age of 18 living in the household *

Home Address (Include City, State) *

Zip Code *

Work Address (Include City, State)

Zip Code

If Owned, Land Address (Include City, State)

Zip Code

Second Family Member

First Name *

Last Name *

Second Family Member Birth Date *

Second Family Member Email

Second Family Member Phone

Third Family Member

First Name *

Last Name *

Third Family Member Birth Date *

Third Family Member Email

Third Family Member Phone

Fourth Family Member

First Name *

Last Name *

Fourth Family Member Birth Date *

Fourth Family Member Email

Fourth Family Member Phone

Fifth Family Member

First Name *

Last Name *

Fifth Family Member Birth Date *

Fifth Family Member Email

Fifth Family Member Phone

Sixth Family Member

First Name *

Last Name *

Sixth Family Member Birth Date *

Sixth Family Member Email

Sixth Family Member Phone

Seventh Family Member

First Name *

Last Name *

Seventh Family Member Birth Date *

Seventh Family Member Email

Seventh Family Member Phone

Eighth Family Member

First Name *

Last Name *

Eighth Family Member Birth Date *

Eighth Family Member Email

Eighth Family Member Phone

Ninth Family Member

First Name *

Last Name *

Ninth Family Member Birth Date *

Ninth Family Member Email

Ninth Family Member Phone

Tenth Family Member

First Name *

Last Name *

Tenth Family Member Birth Date *

Tenth Family Member Email

Tenth Family Member Phone

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Join the Fight for Environmental Justice by Referring Family, Friends, and Coworkers to Enroll in the Los Angeles County Landfill Lawsuits.

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Third Family Member

Fourth Family Member

Fifth Family Member

Sixth Family Member

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Tenth Family Member

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