Membership Application

Associate, Retired, and Student Membership Application for Monthly EFT Payors via ACH

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This field is for validation purposes and should be left unchanged.
Membership Type*
Name*
First Last
Degrees*
Last 4 Digits of SSN*
Address*
Street Address City State ZIP Code
Phone*
Email*
Enter Email Confirm Email
Employer
US Citizen?*
- Yes
- No
Date of Birth*
Month
Day
Year
Member dues include ONA dues. One dollar ($1.00) per month of your dues goes to an account set up to support ONA’s political efforts, if you are a U.S. Citizen. You may choose at anytime to opt out of this dues designation. Opting out does not reduce the dues amount. If you are interested in opting out, please contact the Director of Governmental Relations and Political Advocacy at 614/365-9000. Non-U.S. Citizens are opted out automatically as required by Ohio law. Payment plan option can only be changed during December 1st through December 31st. If you have questions please contact the Membership Department at support@ohnurses.org. ONA dues are nonrefundable. Your category from the list below determines your dues amount.
Dues Payment Schedule/Method
- ACH/Bank Account, Monthly
Retiree Dues Payment Schedule/Method
- Credit Card, Annually
- Monthly EFT
Annual Associate Member Dues
Price:
Annual Retired Member Dues
Price:
Monthly Retired Member Dues
Price:
Annual Student Member Dues
Price:
Associate Monthly Deduction
Price:
Monthly payments are automatically deducted via ACH from your checking or savings account. By signing up for this payment plan, you authorize ONA to withdraw monthly dues payments via ACH on or after the 15th day of each month from your checking or savings account. The amount deducted includes a 33 cent service fee. ONA is authorized to change the amount withdrawn by giving you (30) days notice. You may cancel this authorization upon receipt of ONA of written notification of termination twenty (20) days prior to the deduction date designated above. ONA will charge a $15.00 fee for any returned ACH transactions.
Name of Bank*
Bank Account Number*
Routing Number*
Account Type*
- Checking
- Savings
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
I authorize the Ohio Nurses Association to withdraw monthly dues payments via ACH on or after the 15th of each month from the account specified above.*
If you agree, type your full name in this field.
It is recommended on your behalf to print and keep this for your records.