APPLICATION FOR MEMBERSHIP  
Please complete this form and mail with your check made payable to the Surety Association of Ohio to: 
Hobe & Lucas
c/o Bill Wildenheim
4807 Rockside Road
Suite 510
Cleveland, Ohio  44131

Also email a copy of this form and your check to laura.hall@libertymutual.com
PayPal link: https://ohiosurety.com/event/2024-soa-membership/

Names of Applicants for Roster (add additional names at the bottom of form): 
1.  _____________________________  E-mail address * _________________________ 
2.  _____________________________  E-mail address * _________________________ 
3.  _____________________________  E-mail address * _________________________ 
*This information is very crucial. ALL invites and notices are sent via e-mail. 
Mailing address (for billing purposes) ________________________________________ 
_______________________________________________________________________ 
Telephone # _________________________ 
Which member of your company will be responsible for paying the dues (or other fees) for your company/agency?

 
________________________________________________________ 
Would you be interested in participating in any of the committees or serving as a member of the 
board?  If so, please indicate your interest. 
Technology Committee ____
Government Relations Committee _____ 
Promotion/Education Committee _____ 		Meetings/Membership Committee _____ 
Board Member _____
Other (specify) ____________________ 
Please include a check for $250.00 payable to the Surety Association of Ohio when you return 
this form. 
Thank you for your interest in joining the organization and we look forward to your participation!
Surety Association of Ohio  

Company Name: _________________________________________________________