Membership Application

Name of Library:*

Address:*

Address:

City:*

State:

OHIO ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WASHINGTON, D.C. WEST VIRGINIA WISCONSIN WYOMING

Zip Code:*

County:*

Country:

Does your library have an OCLC Symbol?*

Yes

No

If your library has an OCLC Symbol, what is it?

Whom should we contact at your library regarding this application?

Name:*

Phone:

Fax:

Email:*

Please indicate category of OHIONET membership for which you are applying *

Premium

Member

In what services are you interested?

Library supplies & equipment

Continuing education

Electronic resources/Reference databases

OCLC Cataloging

OCLC Resource Sharing

Web design/development

Technology management (proxy/web hosting, shared server)

Other (Please specify)

Please indicate the month and year you would like your membership to begin.

Month:

Year:

Library tax information (check all that apply):

We are tax exempt, and will provide our tax exempt form at a later date.

We are a government agency.

We use direct payment and will provide a copy of our permit at a later date.

We are NOT tax exempt.

Membership applications are subject to final approval by the OHIONET Board of Trustees.

Memberships require a written OHIONET Membership Agreement signed by both OHIONET and the Library.

OHIONET offers two levels of membership to meet the needs of your institution – Member and Premium.

OHIONET membership will be automatically renewed and billed annually on July 1 until one party provides 60 days prior written notification to cancel membership.

We (the member institution) agree to follow OHIONET policies and to pay for services as they are rendered according to the OHIONET price list and amendments as distributed by OHIONET.

Your Name:*

Title:

Email: