The OMNI User
Individual Membership Application
Instructions: Print this application from our web site, fill out as much of the information as you can (neat printing please), sign the statement at the bottom of the form, then mail it and a $50.00 check to: The OMNI User, 2021 W. Midwest Road, Suite 200, Oak Brook, Illinois, 60521. You will immediately be placed on our mailing list if you are not already there and will be entitled to all other benefits of an OMNI User!
| Your Name (First, MI, Last): | ______________________________________________ |
| Title: | ______________________________________________ |
| Company Name: | ______________________________________________ |
| Mailing Address: | ______________________________________________ |
| E-mail address: | ______________________________________________ |
| City, State, Zip: | ______________________________________________ |
| The address above is: | Home address______ Business Address:______ |
| E-mail address: | ______________________________________________ |
| Daytime Phone: | ______________________________________________ |
| Fax Number: | ______________________________________________ |
I have read the OMNI Bylaws and agree to be bound by them. I am aware that the Board of Directors has the right to discontinue my membership should I be found in violation of said Bylaws.
Signed ____________________________________________ Date__________________________