Name

Title

Organization

Address

City

State

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Zip Code

Phone Number

Fax Number

Email Address

(Please select membership type)

Individual Member

$50

Non-Profit Member

$75

Local Government/Municipality Rates

$150 for Population less than 20,000
(1 Member)

 

$275 for Population more than 20,000
(2 Members)

Business Rates

Community Associate: $150-$499
(1 Member)

 

Community Collaborator: $500-$2,499
(up to 3 Members)

 

*Community Builder: $2,500-$4,999
(up to 5 Members)

 

*Corporate Investor: $5,000-$9,999
(up to 7 Members)

 

**Corporate Partner: $10,000 and above
(up to 10 Members)

Business Amount

I want to make a tax-deductible contribution in support of the Oklahoma Community Institute:

$50

$50

$75

$75

$100

$50

Other

$

Credit Card Type

VisaMaster Card

Cedit Card Number

Expiration Date

JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201020112012201320142015

*Community Builders and Investors will be listed in OCI publications and conference materials.

**Corporate Partners will be listed in ALL OCI publications, conference materials, and have the option of representation on the OCI Board of Directors.

Local Government and Business Members: Please email a list of additional members with application if your membership type calls for more than one member. (Not Applicable for Local Government "Population less than 20,000" or Business "Community Associate" memberships.)

 

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