Antitrust Review Program Registration Form I wish to register the undersigned public entity for participation in the Ohio Attorney General's Office Antitrust Review Program. I understand that any public entity may withdraw from this program at any time. *Name of Ohio public entity: *Type of entity: *Mailing Address: *City, Zip Code: *Name & Title of Contact Person: *Phone & Email of Contact Person: Name & Title of Person Completing Form (if different): Phone & Email of Person Completing Form: *required information You may print this form and mail it to: Antitrust Review Program, Ohio Attorney General's Office 150 East Gay Street, 23rd Floor Columbus, OH 43215 Or you may fax it to (866) 473-4883 American LegalNet, Inc. www.FormsWorkFlow.com