Membership Application

September 2010 - May 2011

Apply or renew online at www.teeoca.org

Please check here if any of the following information has changed from last year.

Name

Title

Company

Address

Telephone Fax

E-mail

E-Mail CHANGE FROM LAST YEAR?_______ WILL YOU SERVE ON A COMMITTEE? YES______

PLEASE SELECT ONE: PROGRAMS _____ MEMBERSHIP _____ COMMUNICATIONS _____

SPECIAL EVENTS ______ NOMINATING _____

DUES: $50.00 MEMBERSHIP ONLY / WITH MEALS $210.00 STUDENT DUES: $15.00

PLEASE RETURN APPLICATION WITH PAYMENT BY October 31, 2010 TO:

TEEOCA FID#73-135-7268
P.O. BOX 1542 - TULSA, OK 74101-1542
Questions or Comments, please contact: Brenda Koss / brenda@teeoca.org

TEEOCA INFORMATION ONLY: received ___________ amount __________ check # ___________