OMLEA Membership Application

Type of Membership

p Administrator/Staff    --Administrator’s Name and School __________________________________________

 p Non-administrator    ($25)

p Student ($10) College or University _________________________
Advisor’s Signature_________________

Name _______________________________________________________________________________

Home Address______________________________________________________________________________

Home Phone_______________________________________________________________________________

E-mail _______________________________________________________________________________

School___________________________________________Position__________________________________

School Address_____________________________________________________________________________

School Phone______________________________________________________________________________

Special Areas of Interest:_____________________________________________________________________

Please return this form and your check (if applicable) to:

CCOSA/OMLEA 

2901 N. Lincoln Blvd.

Oklahoma City,  OK  73105

If you have questions, please call Sherry Rowan at (405)525-8818