LOMA Society of Ohio - 2017 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 stacey.gipson@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  
ASRI  
CPFS   CPLHI  
FFSI   FSRI   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 stacey.gipson@wslife.com if over 1000 characters)

Please indicate what Membership Fee this application is for: $100.00 "All in" Fee  $35.00 "Basic" Fee

My name and business can be listed on the website: No Yes

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

LOMA Membership All-in-fee $100.00 or $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 $100 or $35.00 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
Amy Burchette
One Nationwide Plaza, 1-33-102
Columbus, OH, 43215

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