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!!