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Membership Application

PLEASE PRINT THIS OFF AND MAIL OR E-MAIL TO:

Post Office Box 28787 * Columbus, OH 43228

614.795.4145 * info@ohiolobby.org

Once approved, you will receive an invoice for 2010 dues and instructions for submitting a photo and information for the directory.

Name_________________________________________________________

Organization ___________________________________________________

Mailing Address ________________________________________________

City/State/Zip __________________________________________________

Business Phone _______________________  Cell: _____________________

E-mail __________________________________ Fax: __________________

Organization Web site ____________________________________________

Do you want your cell phone number listed in the printed directory?     Yes ___  No ______

Do you want your cell phone number listed in the online directory?       Yes____  No ______

Do you want your Web site available by link from the OLA Web site? Yes ____  No ______

Number of years with present employer ______________________________

Percentage of time devoted to lobbying ______________________________

(NOTE: must be at least 50%, unless you are in the “revolving door” year.  Those in the “revolving

door” year are eligible for membership as long as their job will eventually be as a lobbyist.)

List two members of the Ohio Lobbying Association who have agreed to sponsor your membership in this association.
_______________________________________________________________________________

_______________________________________________________________________________

I agree to abide by both the Bylaws and  Model Standards of Conduct of the Ohio Lobbying Association (Note: The OLA Model Standards of Conduct may be found at http://ohiolobby.org/about/ola-model-standards-of-conduct/

and the OLA Bylaws at http://ohiolobby.org/about/bylaws/.

Signature: ____________________________________________________________________

Annual dues are $200 EACH for the first four members from your company.  Fifth and subsequent members may be added for $50 each.  Please copy and complete this form for each additional prospective member. NOTE:  Do not send payment.  You will be invoiced once your application has been reviewed and approved by the Board of Trustees.