Agency Membership Information

 
Agency Name:
 
Official Delegate:
 
Address:
 
City:
 
State:
 
Zip Code:
 
Daytime Phone :
 
Fax Number:
 
E-mail:
 
Agency membership for the year of :
 


Annual Membership Dues Invoice
(OALPRP Tax ID 31-1243306)

Annual dues are $75.00
Note that an Agency Membership includes all personnel working within the agency.
Please supply a list of personnel and designate a person authorized to vote for the agency.

MAKE CHECK PAYABLE TO: OALPRP

Susan Helterbran, OALPRP Secretary
Champaign-Shelby County NCOSWD
1512 S, US Hwy 68, Suite G104
Urbana, Ohio 43078