OHIO GAS ASSOCIATION
200 Civic Center Drive, Suite 110
Columbus, Ohio 43215
614-224-1036 Fax: 614/224-1097
www.ohiogasassoc.org email: ohiogas@aol.com
AFFILIATE MEMBERSHIP APPLICATION |
| Please Print YOUR NAME ___________________________________________________________ |
| Company _________________________________________________________________ |
| Address/Shipping ___________________________________________________________ |
| City_______________________________ |
State ___________ |
Zip _____________ |
| Phone _____________________________ |
Fax ______________________________ |
| Email _____________________________ |
Webpage _________________________ |
| ANNUAL DUES: $245.00 PER YEAR |
| Enclosed is check # ___________ in the amount of $______, which is payment for Affiliate Membership for the calendar year beginning ____________________. |
| Signed ______________________________ | Title _____________________________ |
| Please include the following associates from the company on the mailing list: |
| Name _____________________________ |
Address if different _________________ |
| Name _____________________________ |
Address if different _________________ |
| IMPORTANT: Give complete description of company services/products below (or mail brochures). Your information will be printed in the OGA Membership Roster (at next revision). |
| .________________________________________________________________________ |
| .________________________________________________________________________ |
| .________________________________________________________________________ |
| .________________________________________________________________________ |
| .________________________________________________________________________ |
