OAAI Public Service Application

Program Application

(To download an application in PDF format click here)

Organization:________________________________________________

Contact Person:______________________________________________

Address:___________________________________________________

City:____________________State:_________Zip Code:______________

Phone:_____________________Fax:_____________________________

Email:________________________________

Organization's Exempt Status:_____________________

Name of Campaign/Project:____________________________________________

Markets Requesting: (Counties or Cities) OR if statewide, please indicate.

__________________ ___________________ ____________________

__________________ ___________________ ____________________

__________________ ___________________ ____________________

__________________ ___________________ ____________________

__________________ ___________________ ____________________

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(Please continue list on back if needed )

Project Budget: ______________________

Copy Provided by : OAAI _______________Advertiser :___________________

Requested time period for display :__________________

Are you currently an active member of OAAI? ________Yes ___________No

Applicant ‘s Signature:_____________________________Date:________

  Please return to: Rose M. Trader – Executive Director

OAAI 
P.O. Box 7224
Springfield , IL 62791-7224