DAS Registration - OAHU - Ohio Association of Health Underwriters

OAHU
Administrative Office
1545 W. 130th St., Ste. A2
Hinckley, OH 44233
330-273-5756
jackie@ohioahu.org
www.ohioahu.org

OAHU Lobbyists
John McGough
Keith Shoemaker
(614) 221-5771

NAHU
National Association of
Health Underwriters
www.nahu.org

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2010 Day at the Statehouse
Registration Form

Cost: $15/OAHU PAC Capitol Club Member
$35.00/OAHU Member
$50.00/Non OAHU Member

Please fill out the form below to submit your registration to OAHU.

First Name: Last Name: *Company:
Home Address: *E-mail Address:
*Membership: I am a Local Chapter:
List the name and company of any additional people you are registering and indicate whether they are a Capitol Club Member, OAHU Member or Non-member:
Credit Card Information
Name on Card (if different from above):
Billing Address (if different from above):
Credit Card Number: Expiration Date:
Total Amount to be charged:
I acknowledge that my credit card will be charged the amount indicated above. NOTE: Your charge will be listed as "Best Benefits Club" on your statement.