Memo Template w Logo - Midpeninsula Regional Open Space District

Slender False Brome Integrated Pest Management Program
Participation Form
Thank-you for participating in the Slender False Brome Integrated Pest Management Program. We
appreciate your effort to help MROSD control this noxious weed and preserve the health of the redwood
forest.
By participating in this program I agree to:
Treat Slender False Brome (Brachypodium sylvaticum) following the pest control
recommendations provided by MROSD.
Treat Slender False Brome only within the areas designated in the Pre-Treatment Survey of the
property.
Follow all Protective Measures described in the Slender False Brome Control Practice
Recommendation.
Complete control practices in a timely manner.
Schedule a Post-Treatment Survey of the property with MROSD.
Schedule a follow-up visit (6 months) after treatment with MROSD in order to monitor the longterm
effectiveness of the control practice.
Accept reimbursement program payment limits.
Reimbursement at the amount specified will be made only after a post-treatment survey has been
conducted and all protective measures have been followed.
That if a protective measure has been violated, reimbursement will not be made until the violation
has been corrected.
Control practices implemented prior to the pre-treatment survey of the property are ineligible for
financial reimbursement.
Once a reimbursement check has been cashed, the agreement between the participant and
MROSD shall be concluded.
Participant Signature
Date
MROSD Signature
Date
Ellen Gartside, Slender False Brome Coordinator
egartside@openspace.org
650.691.1200
Midpeninsula Regional Open Space District
330 Distel Circle
Los Altos, CA 94022
www.openspace.org
5/12/2009

Name/Participant
Participant Number (assigned by MROSD)
Address/Property
Property ID (assigned by MROSD)
Telephone
Email