OIOA Membership Application

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Once your information is received by the treasurer, the application will be presented to and voted on by the board. You will be notified by email when this is complete and given payment instructions at that time. The application fee is $25, of which $20 is applied to the first year of membership dues.

Email *

Type of membership requested (see www.oioa.org for descriptions): *

Active

Student/Associate

Name *

Gender:

Female

Male

Prefer not to say

Clear selection

Title *

Agency/University *

Years of experience *

State your qualifications (background, training, etc): *

Degrees, honors or certifications:

Name of Sponsor (current OIOA member in good standing) *

Sponsor email or phone *

Have you ever been convicted of a crime? *

Yes

If yes, please provide the details:

Home address (include city, state, zip) *

Home phone *

Work address (include city, state, zip) *

Work phone *

Would you like mail sent to your home or work address? *

Home

Work

Would you like an OIOA lapel pin for $5? Your total due will be $30 if you choose this option. *

Yes

How would you like to pay the membership fee? Payment is not due until your application is approved by the board. *

PayPal online - you will receive an invoice to the email address you provided

Check - please mail to the OIOA Treasurer, 6077 Far Hills Ave. #113, Centerville, OH 45459

Send me a copy of my responses.

Submit

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