Associate Individual Membership Application

Your Dues Rate Type is: Associate Individual $500.00

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Please enter the Username/Password you would like to use to login to this website.

  • Your Username must be unique and must be at least 6 characters.
  • Passwords must be a minimum of 8 alpha-numeric characters with at least 1 number or 1 letter.
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Amount to Charge :
Payment Method:

Enable Automatic Renewals?
Select "Yes" in order to be enrolled in automatic membership renewal. The above payment method will become your saved payment method, overwriting anything that may have been previously saved and will be used for future renewals. You can change the automatic renewal setting or saved payment method at any time in either the "Payment Method" or "Membership Auto-Renewal" tabs where you edit your profile.
 



 


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PO Box 1073 | Columbus, OH 43216 | info@ohioselfinsurers.org | 614-340-3530
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