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Nomination Form

Association of Ohio Commodores

New Member Information – Summer 2024

Initiation and member fees are due prior to induction – $250.00 (initiation fees) plus $150.00 (1/2-year membership fee), total amount due $400.00. Nominees must be in attendance at the June 15th, 2024 meeting in order to be inducted as an Ohio Commodore member. Forms must be completed and returned with listed sponsors by April 20, 2024. Incomplete applications and those received after April 20, 2024 will be added to the Winter 2024 Meeting.

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Specify preferred mailing address: (please check one)

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**Preferred contact information will be printed in the membership directory

If you would like limited information published, please note:

(Please type or print legibly and include biography to be read at induction)

Name as it should appear on certificate:

Name as it should appear on name badge:

Business Name:

Title:

Business Address

Street Address Address Line 2 City Ohio County ZIP / Postal Code

Telephone:

E-mail Address:

Website

Country of Citizenship:

Assistant’s Name (if applicable):

Assistant’s Tel:

E-mail:

Nature of Business, i.e., industry sector and product line or service:

Home Address:

Street Address County ZIP / Postal Code

Home Phone:

Home E-mail:

Spouse’s Full Name (if applicable):

Spouses E-mail Address:

On a separate sheet submit your comments on why applicant should be considered for service to the State of Ohio deserving appointment to the Executive Order of the Ohio Commodores.

Sponsor Name:

Co-Sponsor Name:

The Association of Ohio Commodores, P.O. Box 273, Buckeye Lake, OH 43008 Phone: (614) 440-9323, or email: [email protected] The Association of Ohio Commodores, Inc. operates without discrimination as to age, sex or national origin.