Member Application

Thank you for your interest in becoming a member of the OIADA. Please contact our office if you have any questions at 614-863-5800.

Business Information

Company Name: *

Leave Blank:

Phone: *

Email: *

Business Description (200 char max): *

Directory Category:

Employees:

Full-time Part-time

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Primary Contact Information

First Name: *

Last Name: *

Phone: *

Email: *

Contact Preference:

Email Phone

Password: *

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

Dealer Member: $395.00
This membership is for Dealers Only. Associate Member: $395.00
This membership is for Associate Members Only

Payment Option:

Charge my credit or debit card