ONPS Membership Form

Submission Date

New or Existing Membership?*

New MembershipRenewal of Membership

Member's First Name*

Member's Last Name*

Member's Address*

Street Address

Street Address Line 2

CityState

Zip Code

Has your mailing address and/or phone number changed since your last membership application?*

NoYes

Please provide your old address and/or phone number that we need to remove from our database so that ONPS correspondence is directed appropriately.*

Cell Phone Number

Area CodePhone Number

Home Phone Number

Area CodePhone Number

Do you wish to have your phone number(s) added to the ONPS membership directory?

YesNo

Local Chapter Affiliation (not required)

Northeast Chapter (Great Tulsa Area)Cross-Timbers Chapter (Greater Stillwater Area)Central Chapter (Greater OKC Area)

E-mail to include in membership directory:*

How would you like your Gaillardia (the ONPS newsletter) delivered?

Please send a hard copy via mail.Please send an e-copy via email.I prefer to receive both a hard copy and an e-copy.

Once payment type has been selected below, the remaining payment information will appear.

Payment Type?*

Check (click here if seeking free Student Membership)Credit Card (via PayPal)

Membership Types*

Student Membership (with faculty sponsorship) FreeStudent Membership (without faculty sponsorship) $10.00Individual Membership $20.00Family Membership $25.00Lifetime Individual Membership $300.00Lifetime Family Membership $350.00

Membership Types

Student Membership (without faculty sponsorship)$10.00

If seeking free membership with faculty sponsorship, click on "Check" for Payment Method above.

Individual Membership$20.00

Family Membership$25.00

Lifetime Individual Membership$300.00

Lifetime Family Membership$350.00

Total $0.00

Email of Faculty Sponsor (must be .edu)*

Name of additional family member to include in family membership:

Family Member's First NameFamily Member's Last Name

After you click the "Submit" button below, you should recieve an email verification. Please keep this email for your records and follow the instructions for submitting membership payment.

After you click the "Submit" button below, you should receive an email verification once payment has been processed. Please keep this email for your records.

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.