Name________________________________________________

Company_____________________________________________

Business Address______________________________________

City__________________________State_______Zip_________

Phone (   )__________________Fax (    )___________________

Email Address ____________________________________________

Home Address__________________________________________

City__________________________State_______Zip__________

Phone (   )________________________________________

Spouse’s Name______________________________________

Date presented to Board of Directors_______________________

Date elected at a regular Association meeting________________

Date and amount received_______________________________

Privileges not extended to associate members:

• Voting

• Holding

• Nominating candidates for office

• Attending closed meetings

Mike Stevens
Cox Ohio Publishing
5000 Commerce Center Dr.
Franklin, OH 45005
(937) 603-5211