OLMR MEMBERSHIP FORM

OLMR MEMBERSHIP FORM

OLMR believes that families and individuals have the right to choose a residential, educational, and/or employment setting that meets their unique needs, and the system not be a “one size fits all”. Please join in our advocacy efforts to give our loves ones the best possible options. We need your help. Together, we can make a difference!

Name: _________________________________________________________________

Address:________________________________________________________________

County:____________________________ State:__________________ Zip:__________

Home Phone:________________________ Cell Phone:__________________________

Email Address:___________________________________________________________

Please mail completed form along with a check to:

OLMR Treasurer

C/O Becky Ewing

P.O. Box 513

Apple Creek, OH 44606

Individual Membership: $30.00 __________

**Organizational Membership: $250.00 ___________

Corporate Membership: Min. $2,000.00 ___________

Contributions: _____________________

**Organizational memberships who have individual members wishing to receive full member benefits including the

newsletter need to pay an additional $12.00 per member. Please provide address for each additional member:

OLMR is a 501(C)(3) tax exempt organization. Your contributions may be tax-deductible.

OLMR

Rich Klein, Executive Director

2356 Sherwood Court

Xenia, OH 45385

Phone: 937-376-0259

Email: richklein18@gmail.com