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Check one: ______ Renewal _____ New _____ Change of Address
Name____________________________________________________
Spouse Name______________________________________________
Address___________________________________________________
City_______________________State___________Zip Code_________
Home #______________________Work #________________________
Email address_______________________________________________
Profession/Industry__________________________________________
Spouse’s Profession/Industry___________________________________
Membership dues include membership to:
OCA National - includes the magazine IMAGE, membership discount for OCA National Convention and other OCA National events/programs.
OCA-NOVA - includes INNOVATOR newsletter, discounts to selected Chapter events and programs.
Check one:
____ Family ($40) ____ Individual ($25)
____ Senior ($20) ____ Student ($20)
____ Lifetime Family ($1,500) ____ Lifetime Individual ($1,000)
____ Corporate ($1,000) ____ Corporate ($500)
____ Gold Circle ($250) ____ Silver Circle ($100)
____ Check here if you would also like to join the OCA-Young Professionals
of which $5 of the above dues will be forwarded to OCA-YP.
We need everyone’s participation! Please let us know your interests (please check all that apply)!
_____ Membership _____ Social activities
_____ Community Service _____ Legislative Issues
_____ Chinese language & culture _____ Networking
_____ Newsletter _____ Fundraising
______Other (fill in ______________)
If you are interested in a mentoring program, please check the appropriate box below:
______ I am interested in serving as a mentor
______ I am interested in finding a mentor
______ I may be interested in the program but would like more information
Please make checks payable to: OCA-NOVA
Mail with membership form to: OCA-NOVA, P.O. Box 592, Merrifield, VA 22116.