2010-2011 Teeoca Membership Application

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 / [email protected] TEEOCA INFORMATION ONLY:

received ___________

amount __________ check # ___________