Membership Form

Please fill out the form below and click send. You will then be redirected to a webpage to pay your dues.

    Date (YYYY/MM/DD)

    Full Name (required)

    Spouse or Significant Other Name

    Street Address (required)

    City (required)

    State (required)

    Zip Code (required)

    Home Phone Number (required)

    Cell Phone Number

    Email (required)

    Please choose one of the following:
    Ohio State GraduateNon-GraduateOhio State Non-Alumni
    Ohio State Graduate includes associate, bachelor, graduate, professional, honorary, or medical resident graduates.
    Ohio State non-Graduate includes persons who did not graduate from Ohio State, but were in good standing as dues-paying members as of July 1, 2012, as either Life Members or Annual Members of the Alumni Association.
    Ohio State Non-Alumni includes all other non-alumni who choose to belong to the club.

    Occupation

    Ohio State Degree(s)

    Year(s) Graduated Ohio State

    Membership Type (required)

    If you are a new member, how did you hear about us?

    Current Ohio State Alumni Association Sustaining Member (required)

    Alumni Association Number

    Interested in serving on the board

    Interested in serving on a committee

    Comments