Please select the membership of your choice:
_____ Organizational member ($300)
_____ OHN Member ($100)
_____ Individual member ($100)
_____ Student Member ($25)
_____ Associate member ($500)
____ OHN Industry Council Member ($200)
Please provide the following contact information:
Name of Individual or Organization: _______________________________________________________
Contact Person for Organization: ________________________________________________________
Mailing Address: ______________________________________________________________________
Phone Number: _______________________________________________________________________
Email Address: _______________________________________________________________________
Please mail your completed membership enrollment form and a check in the appropriate amount to:
Jo Bell, Treasurer
Telehealth Alliance of Oregon
50523 Linnwood Drive
Gates, Oregon 97346
For more
information please contact:
Cathy Britain at csbritain[at]gmail[dot]com or
Jo Bell at membership[at]ortelehealth[dot]org.
THANK YOU FOR YOUR SUPPORT!!