ONPS Membership Form

Submission Date

New or Existing Membership? *

New Membership Renewal of Membership

Member's First Name *

Member's Last Name *

Member's Address *

Street Address

Street Address Line 2

City State

Zip Code

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

No Yes

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 Code Phone Number

Home Phone Number

Area Code Phone Number

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

Yes No

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 Credit Card (via PayPal)

Membership Types *

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

Membership Types

Student Membership (with faculty sponsorship) Free

Student Membership (without faculty sponsorship) $ 10.00

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 Name Family 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.