Membership Application Form

€ Plant Processing Inspection is ___ Federal Inspection ___ State Meat Inspection ___ ODA-Food Safety Inspected ___ Health Department ___ Custom Exempt	€ Supplier A company which offers equipment, supplies and/or services to meat processors of Ohio.	€ Educational An institution of education which offers courses related to the meat and poultry industry,
Retail Store Inspection is ___ State Meat Inspected ___ ODA-Food Safety Inspected ___ Health Department	€ Affiliate A company which is non-meat or poultry related but utilizes one or more membership services.	€ Association An organization and/or association which utilizes one or more membership services.

Please Print:
Name of Company Primary Representative: ______________________________________
Company Name: ____________________________________________________________
Company Address: __________________________________________________________
City/State/Zip: ______________________________________________________________
County in Ohio: ____________________Web Page Address:________________________
Phone Number: ______________________ e-Mail address: _________________________
Sponsor: __________________________________________________________________ Fax: ___________________________________________

Return this membership application form completed with your check to: Ohio Association of Meat Processors, 6870 Licking Valley Rd., Frazeysburg, OH 43822. Phone 740-828-9900 with questions.