LOMA Society of Ohio - 2012 Membership Application

If you have trouble using this page, simply print it, fill it out, and send it to the address shown below.
Please email paul.anhofer@wslife.com with any issues using this page.

First Name:
Last Name:
Company:    if other....
Position:
Business Address:
Line1:
Line2:
City:
State:
Zip:
Business Phone (ex: xxx-xxx-xxxx) :
Extension:
Email Address: Email Address Verify:
Home Address: (OPTIONAL)
Line1:
Line2:
City:
State:
Zip:
HOME Email Address:

Membership eligibility is based on attainment of at least one of the following LOMA designations.
Acheived LOMA designations:
FLMI  
FLMI-Master  
AAPA   ACS   AFSI  
AIAA   AIAF   AIRC  
ALMI   ARA   ARP  
CPFS   CPLHI  
FFSI   PCS  

  Other professional designations:

  Please consider becoming a member of one of our committees.
I am interested in being contacted for further information on:
Program (Coordinates meetings and programs)
Public Relations (promotes society activities)
Membership (Recruiting and maintaining membership database)
Education (Coordinates all society educational activities)
Volunteer (Various other Opportunities)

  Suggested Meeting Topics / Improvements / Comments: (email paul.anhofer@wslife.com if over 1000 characters)

My business information can be listed on the website: No Yes

New Members Only:
   How did you hear about us?
   if other....(max 50 char)

LOMA Membership $35.00

An email will be sent to you at the email address supplied to verify the application was received. Print the email and send it with your membership $35 payment to the address below (address also included in the email). Please submit payment within 90 days to validate your application.

LOMA Society of Ohio
P.O. Box 271
Cincinnati, OH, 45201-0271

Western & Southern associates can send mail to Joanie Hagedorn - MS#03.