Individual Membership

Complete the Form Below for OMLA Membership

When completed, you can submit the form an pay by either of the following ways:

OMLA Membership

P.O. Box 289

Fort Loramie, OH 45845

First Name:

Last Name:

Institution:

Address:

City:

State:

Zip Code:

County:

Phone:

Email:

Membership Status

Title:

Type of Membership:

Individual Membership, Price $30.00

Undergraduate College Student Membership, Price $15.00

Free Text

* Membership includes (1) election vote.

* Dual individual OMLA / AMLE memberships are available through AMLE. Call 1-800-528-6672 or visit www.amle.org

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Yes

If yes, please type the owner's name that is on the credit card being used. After you submit, click PAY NOW on next page.