Portagecountysafetycouncil.files.wordpress.com



Portage County Safety CouncilA Forum for Workplace SafetyDate: Due: 7/1/19c/o Family & Community Services705 Oakwood Street, Suite 221Ravenna OH 44266Phone: (330)474-3161Email: portagesafetycouncil@ Thank you for your membership in the Portage County Safety Council! ??Qty Description ? Price__1__ FY20 Annual Membership – July 1, 2019-June 30, 2020 (required)* Only 1 needed per company (or Ohio BWC policy number) $85.00 _____ FY20 Annual Prepaid Lunch Package (optional)* Includes 1 monthly lunch for 1 employee representative per package [$15ea x 11 months = $165 + 1 lunch free] $165.00each*Refunds are not available?????Amount2019-2020 Total Enter Amount Paid?Company Name:_________________________________ Ph #: __________________________________Method of payment: ___Check ___Credit CardMake checks payable to "Portage County Safety Council"Check #__________________________ We accept Visa Master Card Discover American ExpressAccount Number________ ________ ________ _______ Exp. Date ________ /_________ Security Code ________________(on back of card)Name on card:___________________________________ Title:___________________________________Billing Address:___________________________________________________________________________(address on file w/credit card) ................
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