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Membership Form

Please print out the form below and send the completed form and check payable to Ohio Literacy Network to the address below.

1500 West Lane Avenue
Columbus, Ohio 43221

Name _______________________________________
Title _______________________________________
Agency _______________________________________
Address _______________________________________
City _______________________________________
State _______________________________________
Zip Code _______________________________________
County _______________________________________
Work Phone _______________________________________
Home Phone _______________________________________
Membership Type
____ New
____ Renewal

____ Individual $20
____ Nonprofit organization $50
____ Private sector $100+
____ Literacy students, volunteer tutors and volunteer staff $5

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Ohio Literacy Resource Center - Celebrating 10 Years of Enhancing Adult Literacy 1993-2003 This page
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