Membership Form

NAME _______________________________________________________________

E-MAIL ADDRESS _____________________________________________________

MAILING ADDRESS ____________________________________________________

                                        ____________________________________________________

PHONE NUMBER ______________________________________________________

WHICH CATEGORY?    ACTIVE MEMBER ____________    FRIEND ___________

As an Active Member your email will be forwarded to the Stephen Lewis Foundation so that you will receive the Granny Bulletin directly from them. As a Friend Member you will receive OMAS monthly newsletter, the DRUM BEAT.

Please share your employment (present or former) / volunteer work / interests.
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Please indicate your area/s of interest and/or expertise.
                       
                        Chair                           Secretary                        Treasurer

                        Planners                      Education                      Publicity/Promotion

                        Producers             Volunteer Pool (all members become part of this)

I give permission to include my contact information in the OMAS SISKONA
Directory:      Y ___ N ___           Signature: _____________________________________

(If replying by email, copy and paste this form to a WORD file, fill it in, save it  and email it as an attachment to [email protected])