Cincinnati Litho Club

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Cincinnati Litho Club, Inc. Application for Scholarship
*An Educational Oganization for the Advertising, Computer, Digital Imaging, Graphic Arts and Printing Industies*

Name:
Spouse's Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:

Company Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Website:
Position:
Department:
Years with Present Firm:
Years in Industry:

Please include a bried outline of past employment in the industry that should be given proper consideration:

I hereby apply for membership in THE CINCINNATI LITHO CLUB, INC. If approved, I agree to cooperate, abide by and conform to its Constitution and By-Laws.

*Submitting an electronic signature is the same as submitting a signed document

Applicant Signature:		Date:
Recommended By:		Date:
Recommended By:		Date:
I acknowledge that there is a $51.00 fee (includes $16.00 initiation fee and $35.00 annual dues) payable to:
Cincinnati Litho Club, Inc. and returned to: Cincinnati Litho Club, Inc. c/o: Xerox, Chuck Weiner 4270 Glendale Milford Rd Cincinnati, OH 45242