OBTA 2006-2007 Membership Application
For Membership Year July 1, 2006-June 30,2007

Check to exclude your personal data from the directory.
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Title:  First Name:     MI:       Last Name: 
Address: Apt: 
City:    State:    Zip: 
Home Phone: (xxx-xxx-xxxx)    School/Business Phone:   Ext:
E-Mail:      
School/Business Information:    
School/Business Name: 
School/Business Address: 
City:   State:      Zip:     County: 

Position

                                       Institution

    Highest Degree
Classroom   Elementary College/University   Bachelor
Teacher/Educator   Middle/Jr. High School Tech/Comm College   Master
Administrator   Secondary/High School Private Bus. College   Specialist
Supervisor   JVS/Career Center State Department   Doctoral
Student Other    
Other      

Optional Information

                                Dues Information
NBEA Member

       Professional - $45.00 ($40.00 before July 1)
 Yrs in Education:           Retired - $20.00
   OBTA Section Number          Student - $20.00 (Full-time, Undergrad)
         Life Member - No Charge
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Please print form and send with payment to: 
Mary Deloe, Davis College, 4747 Monroe Street, Toledo, OH 43623