 RENEWAL OHIO FEDERATION OF MUSIC CLUBS

 NEW SENIOR SPECIAL MEMBERSHIP

Please complete this form (Print or Type) Date __________________________

Name: ____________________________________________

Address: __________________________________________ City & Zip Code: ______________________________

Phone No: ( ) E-Mail Address: ____________________________________

Are you a Junior Club Counselor?  Yes  No If yes, name of club ____________________________________

Annual dues of $20 include one subscription (3 issues) of

Music Clubs Magazine and 4 issues of Ohio Music Club News. Amount Enclosed __________

Send completed form and a check or Money Order (payable to OFMC) to the State Treasurer,

Richard Rootes, 8860 Colton Street NW, Massillon, OH 44646-1616. Email: RLRootes@netscape.com

*This form may be photocopied, or it is available on-line at: www.ofmc.org