Become a Member

OHIO PRAIRIE ASSOCIATION Membership Application

[To print this form, hit File, then Print, or simply Ctrl+P.]

Name_______________________________________________________________________

Additional Names :

(Family Membership only)____________________________________________________________

Institution/Affiliation_____________________________________________________________

Address_____________________________________________________________________

_____________________________________________________________________

City___________________________ State______ Zip+4 ________________ - ___________

Phone* ( ) ___________________ E-mail*___________________________________*Optional

Amount Enclosed $ __________ Make check or money order payable to:

Ohio Prairie Association

Please send remittance and this form to

OPA Membership

5137 Emerson Rd

Madison, OH 44057-9514

Membership Levels (Please Check One Box)

Student – $10

Regular Member – $20

Family Membership† – $25 †One copy to one mailing address.

Friend – $35

Library* – $35 (*This is a non-voting membership. )

Institutional* – $50 (*This is a non-voting membership. )

Supporting Member – $75

Contributing Member – $150

Life Member – $500 (Payable in up to eight increments over a two year period.)

OPA membership for all members is 1 July through 30 June.

Please check or write the membership year(s) you desire:

2007-08 2008-09 2009-19 ____________

If unmarked, membership will begin and run in current year.