“Serving and supporting physicians in their efforts to improve the health of Oregonians”

Licensed Physician Assistant Membership Application

PROFESSIONAL INFORMATION
LICENSING / EDUCATIONAL INFORMATION
Sponsoring Physician

For Physician Assistants to be eligible for OMA membership, they must be sponsored by a physician who is an OMA member in good standing:

PERSONAL INFORMATION (NEVER SHARED)

(For Alliance Use)

**Newsletters and alerts are sent by email. Please be sure we have your correct email address.

Payment

If there is no day included in your expiration date, select the last day of the expiration month.

OMA Dues for Physician Assistant Members are $75.00. Please make check payable to Oregon Medical Association and mail to 11740 SW 68th Parkway, Suite 100, Portland, OR 97223

AGREEMENT

I hereby apply for membership in the Oregon Medical Association and agree to abide by its bylaws and policies and the Principles of Medical Ethics of the Oregon Medical Association. I authorize the OMA and its affiliates to communicate member benefit information by e-mail and facsimile.

OTHER

Contact the OMA if you have any questions regarding your application at (503) 619-8000 or send an e-mail to oma@theOMA.org.