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Corporate Membership Application or Renewal
Thank you for your interest in becoming a member of The Brain Injury Association of Ohio. You are the backbone of our organization. If you have any questions or problems completing this form, or if you do not receive acknowledgement of your membership, please e-mail Emily Smith at
Name of Designated Representative
A check or money order was mailed to BIAOH, PO Box 21325, Columbus, OH 43221
Payment was made using PayPal (please note your name and "membership" in PayPal's special comments section)
I am a constituent member
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