Membership Application/ Renewal Form

Print, fill out and send to address below.

Name ______________________________________________________________

Title _______________________________________________________________

Institution/
Organization _________________________________________________________

Address ____________________________________________________________

Phone ______________________________ Fax_____________________________

Email _______________________________________________________________

Membership Levels

OK-AHEAD has three membership levels. They are:

Institutional Membership: This membership level covers designated employees of a single campus setting. If there is a multiple campus setting under a single administration, the institutional membership can cover both campuses. Cost is $75.

Associate/ Individual Membership: This membership level covers any employee in any arena related to services for individuals with disabilities including postsecondary institutions. Cost is $25.

Affiliate Membership: This membership level is open to students, parents, advocates and retired professionals. Cost is $10.

Institutional Membership

  $75_______

Associate/ Individual Membership

  $25_______

Affiliate Membership

  $10_______

If you chose the Institutional Membership level, please list the names and email addresses for the designated employees covered under this membership.

Name/Email _______________________________________________________________

Name/Email _______________________________________________________________

Name/Email _______________________________________________________________

Name/Email _______________________________________________________________

Name/Email _______________________________________________________________

Name/Email _______________________________________________________________

Name/Email _______________________________________________________________

Payment

Amount Enclosed __________________________
(PO# required if payment by check not included)

Method of Payment: Check #_________ Purchase Order #________

Make checks and purchase orders payable to "OK-AHEAD."

OK-AHEAD's EIN: 73-1496378

Mail membership application to:

OK-AHEAD
PO Box 42152
Oklahoma City, OK 73123

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