State Employee Discount

Please PRINT this form, SIGN, and MAIL it to us at the address listed below. We’ll do the rest!

Yes! I want to subscribe for $16.95 per year as a State of Oklahoma employee.

Contact Information 

State Agency (where I work) __________________________________________
State Agency Address ________________________________________________

Last Name ________________________________________________________
First Name ________________________________________________________
Home Street Address ________________________________________________
City __________________________ State _______________ Zip ____________

Phone Number (____) _______ - _______________
My Email Address ___________________________

Signature ___________________________________ Date ___________________

Payroll Code - MIOK
Revised OTRD 1/27/04