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Associate Member Application

Thank you for your interest. After your application is submitted, we will submit it to our Board of Trustees for review and adoption. Our director of member services will be in contact with you to update you on your application status.

Question - Required - Organization Name:

Contact Information:

Name:

First Required	Last Required

Email: Required

Street 1: Required

City/State/ZIP:

City Required	State Required	ZIP Required

Phone Number: Required

Email Format:

Question - Required - Description of your company:

Question - Not Required - Your company's web address:

Question - Required - Please indicate the level of membership you are interested in: Silver Level: $500 for organization less than 5 employees.
Silver Level: $1,500 for organizations with more than 5 employees
Gold Level: $5,000
Platinum Level Premier: $9,500

4000 Kruse Way Place
Building 2, Suite 100
Lake Oswego, Oregon 97035
503-636-2204 | Fax: 503-636-8310
info@oahhs.org

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