OAB Membership Application - Radio "*" indicates required fields PhoneThis field is for validation purposes and should be left unchanged.Directory InformationPlease provide the following directory information.License City* City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Licensee / Owner* First Last Call Letters*AM FrequencyAM PowerAM FormatFM FrequencyFM PowerFM FormatNetwork AffiliationsAssociations (RAB, NAB, etc.)TelephoneWebsite Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Studio Address (if different) Same as mailing address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code General Manager* First Last General Manager's Email Address* General Sales Manager First Last General Sales Manager's Email Address Local Sales Manager First Last Local Sales Manager's Email Address Operations Manager First Last Operations Manager's Email Address Program Director First Last Program Director's Email Address Promotions Director First Last Promotions Director's Email Address News Director First Last News Director's Email Address Sports Director First Last Sports Director's Email Address Chief Engineer* First Last Chief Engineer's Email Address* SignatureName* First Last Title*Email* Payment MethodHave you already been invoiced with your membership dues?* Yes, I have received an invoice and am ready to make a payment. No, I would like to receive an invoice. Invoice Number*Amount Due* Payment Options* Credit Card Check The following amount will be charged to your credit card. Note: Please make checks payable to Oklahoma Association of Broadcasters and mail to: 6520 N. Western Avenue, Suite #104Oklahoma City, Oklahoma 73116 Billing Name First Last Billing Address* Same as mailing address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name CAPTCHA
