Renewal form

Thank you for renewing your membership with the Oregon Medical Association. Please fill out the secure renewal form below. If you have any questions please give us a call at (503) 619-8000 or email the membership team at membership@theoma.org.

PROFESSIONAL INFORMATION
LICENSING / EDUCATIONAL INFORMATION

PAYMENT

Please select the membership dues that apply to you.

* 501(c)3 organizations may jeopardize their tax-exempt status by contributing financial support to political organizations like OMPAC. If your dues are paid by a 501(c)3 or if you are personally opposed to contributing to OMPAC, direct your allocation to the Oregon Medical Education Foundation (OMEF), a 501(c)3 corporation

* Some organizations such as public hospital districts or hospitals may be unable under law to contribute to either OMPAC or OMEF. If your dues are paid by this sort of organization select OMA General Fund and your full payment will be directed to the OMA

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. 

Sign by typing your full name in the box above

OTHER

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

v2 2016