Membership Application 1*

Use Tab Key to go to the next field 
or Shift Tab to go back.
Name of field is below box.
OMAHA GROUNDS MAINTENANCE ASSOCIATION

Date   MM/DD/YY
Membership Type 2*

Company Information:

Company Name 
Contact Person 

Street Address
City
--------- 
State                   Zip+4
Office Phone #

Mobile Phone # 
Fax # 

E-mail Address ......

Web Page Address
Personal Information:

First Name
Last  Name

Home Street Address 
City, State Zip 

Pesticide Applicators License # 
Position in Firm  i.e. Owner, Applicator 

Year start Business
Years of Experience 
OTHERS: Optional  
Birthday
                                            List others not listed below
Type of Services offered:
Mowing -  Lawn Chemicals  - Shrub Care - Tree Care - Sprinkler Service Landscaping -
 
Please write your comments or questions or additional information in the box below.
1* Membership Fees are $125.00 per year 
2* Membership types: Regular = Owner - Operator in the Green Industry;   Associate = Supplier to the Green Industry
Please Make Checks Payable to Omaha Grounds Maintenance Association
Mail Payment to: OGMA, PO Box 541203, Omaha, NE 68154-9203
Print this form and mail this application with your fee.

Copyright © JDE Inc. Up-Dated 04/30/2007 09:47:58 PM