THE OHIO POETRY ASSOCIATION
MEMBERSHIP APPLICATION

You may fill out this page online, print it out and mail it in, or you may click, "submit" near the bottom
of the page and your form will be sent to the Membership Chair immediately.
Date of application:   Day:   Year:

For which category of membership are you applying?
Membership Category  


      First Name:   Last Name:

Street Address:             City:

State or Province:   Zip or Postal Code:

Email Address:


We may wish to call you from time to time. May we have your phone number(s)?
(These are optional, but will allow us to provide you with better service.)
Home:  
Work:  
Cell:    

What is the best time to call you?

May we include your name and all contact information in a members directory for distribution to members only?  
We would like to get to know you better. Please tell us something about yourself and your writing experiences.



How did you hear about OPA?



Why do you wish to join OPA?



How do you think you can best contribute to OPA? Are there specific areas you would like to assist or help with?



 
Before you membership is final, you must mail a check or money order in the amount of the Membership Category
that you selected above.
Payment must be sent to:
David Francis Smith
OPA Membership Secretary and Treasurer
5580 Beverly Hills Drive - Apartment B
Columbus, Ohio 43213-6677

Please enclose a note with your name, address and phone number with your payment so that we can clearly identify
your payment with your corresponding online application.


You may submit up to three poems by typing or copy/pasteing into the space below.
One or more of your poems may be included in our print Annual Literary Journal, "Common Threads".
Your work will also be reviewed by the Featured Member commitee for inclusion in our members forum.

You may type or copy/ paste up to three poems into the space below.
Be sure to title each Poem and place 2-3 spaces between each poem.




One Question Survey:
If, you could have submitted your payment at the same time that you did your application online,
Would you have been willing to pay an additional $3.50 processing fee to use pay pal and have instant membership?



Caution="reset" will CLEAR all of your input!

~ . ~
For additional membership information you may email David at: david@ohiopoetryassn.org.
When you submit this form you will be directed to our Members Forum online.
 Please tak a few moments to open a personal profile.
Our main site is: http://www.ohiopoetryassn.org
The Ohio Poetry Association is recognized as a 501(c)(3) charitable institution by the Internal Revenue Service.
 Contributions to the Association are tax-deductible to the full extent of the law.
 © The Ohio Poetry Association
All Rights Reserved