OCLRE Membership Application

First Name
Last Name
School District (if applicable):
Grade level(s):
Work Street Addr:
Work City:
Work State: Work Zip:
Work Phone: Work Ext:
Work Fax:
OH House District: OH Senate
Home Street Addr:
Home City:
Home State: Home Zip:
Home Phone:
Cell Phone:
E-Mail checked most consistently:
My preferred address is: Work Home E-Mail
The best way to contact me is: Phone Fax Regular Mail EMail
OCLRE membership is individual and annual, effective September 1 of each year. Membership is $30 per academic year. Full-time college students are eligible for membership at a reduced rate of $15. College attending should be indicated above. Please choose your membership status/request:
OCLRE has several options for payment. You may pay with a credit card, request OCLRE to issue an invoice, or enter a purchase order (PO) number. If the PO number is not available, you may enter "pending".
Optional information
How did you hear about OCLRE?
Other organization (please specify)
Other (please specify)
   - denotes required fields