Membership Form for MADD Ohio

Yes, I want to enlist in MADD Ohio and help prevent drunk driving, assist victims of this violent crime & help stop underage drinking!

NOTE: You may fill out this form online and then print or

simply print the page and fill it out later.

	Please check one
	Victim/Family of Victim
	Individual Membership
	Organization/Business Membership
Membership is free, but I want to help saves lives by making a donation!
Please make your check payable to MADD Ohio:
Enclosed Amount:	$
Phone Number:	( )
Name:
Address:
City:
State:
Zip Code:
Email:

Mail to:	MADD Ohio 5900 Roche Drive Suite 250 Columbus, OH 45229