Membership Application/ Renewal Form

Print, fill out and send to address below.

Name ______________________________________________________________

Title _______________________________________________________________

Institution/
Organization _________________________________________________________

Address ____________________________________________________________

Phone ______________________________ Fax_____________________________

Email _______________________________________________________________

Institutional I Membership (Postsecondary institutions only) 1-3 members may join from single or multi-campus setting. Please use separate sheet for each member.		$50_______
Institutional II Membership (Postsecondary institutions only) 4-8 members may join from single or multi-campus setting. Please use separate sheet for each member.		$75_______
Associate Membership Employed in any arena related to services for individuals with disabilities		$15_______
Affiliate Membership Open to students, advocates, and retired professionals		Free_______

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
c/o Chimène Long
PO Box 42152
Oklahoma City, OK 73123