Check one: ______ Renewal             _____  New          _____ Change of Address




Spouse Name______________________________________________




City_______________________State___________Zip Code_________


Home #______________________Work #________________________


Email address_______________________________________________




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.