Membership Application

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Please enroll me as a member of the Ohio Tire and Automotive Association. I understand this will provide me with all the
OHIO TIRE AND AUTOMOTIVE ASSOCIATION

Membership Application Please enroll me as a member of the Ohio Tire and Automotive Association. I understand this will provide me with all the membership rights and privileges as outlined in the By-Laws of the organization. OTAA Membership Dues are $175.00. Dues are payable annually. Please make a copy of the form below, fill it out, and mail with payment to: Holly Nagle, Executive Director OHIO TIRE AND AUTOMOTIVE ASSOCIATION 50 WEST BROAD ST., SUITE 1111 COLUMBUS, OH 43215-5912

Business Name: _______________________________________________________________ Street Address: _______________________________________________________________ City, State, Zip: _______________________________________________________________ Owner or Manager Name: ______________________________________________________ Business Phone: Fax: ___________________________________________________________ E-Mail Address: _______________________________________________________________

My signed check is attached _______

Card# _________________– ___________________–________________ –________________ Expiration Date: ____________________________

Security Code: _____________________

Amount: $__________________ Signature: _________________________________

Date: ____________________________