Membership Application

To pay by credit card, fill out this form completely. An asterisk (*) denotes a required field. The following fields are included in the Membership Directory on the Oregon ODN website: name, company, phone, email, web, and specialty areas. Please email info@odnoregon.org if you don't want certain information made public.

First Name*
Last Name*
I'd Like the following type of Membership:


New Regular Membership ($75.00)
Renew Regular Membership ($75.00)
        Member since
New Regular Membership (Hardship, $35.00)
Renew Regular Membership (Hardship, $35.00)
        Member since
New Student Membership ($35.00)
Renew Student Membership($35.00)
        Member since
Attend one Meeting as a non-Member ($10.00) 
Information Update Only (No charge) 
Company
Mailing Address
City
State
Zip
Business Phone
Email
Web Site
Specialty Areas
(80 or fewer characters)
 
Type of Practice External practitioner. Please choose:
       Solo Practice or Group Practice
Internal practitioner
Not currently an OD practitioner

Note: "External OD," as used here, means your OD clients work for a different organization than you do. "Internal OD," as used here, means your OD clients work in the same organization as you do.
I'd Like to Help with:
 (check all that apply)

  Meet and greet at meetings
  Special workshops, events, and/or programs
  Programs Committee
  Public relations (external communication)
  Web Site
  Outreach to other Internal Consultants
  Bringing new members on board
  Community Consulting Project (CCP)
  Offering OD mentoring to other members in
         
  Helping to form a Special Interest Group in
         
  Sharing an area(s) of OD I'm passionate about
         
  It's not on your list, but I'd like to help with
         
  Wherever the need exists
 
Help or Support I Would Like from Other Members (Ask! You might just get what you need.)