RESOLVE of Ohio

Membership Application Form

Print this form and mail it along with your payment to :

  RESOLVE |7910 Woodmont Avenue | Suite 1350 | Bethesda, MD 20814

Rates - Please select a category.

* A letter of scholarship must accompany this membership form.

Please Print:

Name :__________________________________________________

Address:_________________________________________________

City/State/Zip:_____________________________________________

Phone Number: (        )______________________________________

Email address:_____________________________________________

___ My check is enclosed.  (Make payable to RESOLVE of Ohio, Inc.)

___ Please charge my credit card.

            __  Visa          __ Mastercard

            Account Number:  _____________________   Expiration Date:  ______________________

            Signature:  ___________________________   Today's Date:  ________________________

            Telephone number is required for credit card charges. 

If you have questions about RESOLVE of Ohio, please feel free to call our toll-free number at 1-800-414-OHIO or visit our website at www.resolveofohio.org.  It is important to note that RESOLVE of Ohio is a non-profit 501(c)3 organization funded primarily by private donations.  Your support, either through corporate planned giving programs or one-time gifts, is vital to our existence!