Physician Membership Application

We are looking forward to your membership with the OMA! Please fill out the secure application below. Note you will be asked to pay for your membership online once you submit your application.

PROFESSIONAL INFORMATION
LICENSING / EDUCATIONAL INFORMATION
Residencies and Fellowships 1
Residencies and Fellowships 2
Residencies and Fellowships 3
PERSONAL INFORMATION (NEVER SHARED)
PROFESSIONAL AFFILIATIONS

PAYMENT

Please select the membership dues that apply to you.

Payment Method (if paying by check, please make payable to Oregon Medical Association and mail to 11740 SW 68th Parkway, Suite 100, Portland, OR 97223)

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. If my medical license is issued by a state other than Oregon, I agree to notify the OMA of any changes to my licensure status. I authorize the OMA and its affiliates to communicate member benefit information by e-mail and facsimile.

OTHER

If you have any questions, call OMA at (503) 619-8000 or send an e-mail to oma@theOMA.org.

v2 2016