OAPA Membership Application

Contact Information

First Name
Last Name
Preferred Email
Practice Specialty
Home Address CHECK if Primary Address
CHECK if Preferred Mailing Address
Address
City State Zip
Home Phone
Work Address CHECK if Primary Address
CHECK if Preferred Mailing Address
Directory CHECK if you wish to be included in the Directory
Employer
Employer Address
City State Zip
Work Phone Fax
NCCPA Cerficate #
AAPA Certificate #
Ohio Registration #
PA Program Attended
Year Graduated
Highest Degree Attained
Do you wish to be included in rental lists?
I hereby consent to receive faxes and emails sent by, or on behalf of, OAPA. I understand that OAPA will not share my fax number or email address with other organizations unless authorized by me.
I hereby apply for membership in OAPA and agree to support the Guidelines for Ethical Conduct by the Physician Assistant profession and the objectives of the Association. I understand the services to which I am entitled and the date my membership expires, 12 months from receipt of dues payment. I testify the that the information in this application is true and accurate.

Membership Fees:

 
OAPA Now Offers a Three-Year Fellow or Associate Membership for $400!
Fellow Member - Must reside or practice in Ohio and must be an AAPA Fellow Member. Full voting privileges.
Associate Member - Must reside or practice in Ohio. Full voting privileges except on AAPA-specific issues.
Student Member - Must be enrolled in a designated program at an accredited insitution. First Year students=n/c; Second Year students=$25
Health Team - One physician assistant and one or more of that physician assistant's supervising physicians.
Supporting Member - A practicing physician in Ohio.
Affiliate Member - Other individuals or groups.
OPTIONAL CONTRIBUTIONS:
General Fund
Scholarship Fund
Legal Fund
OAPA-PAC
(PAC contributions are not tax deductible)
Please note that OAPA does not accept credit cards by email or fax.

Dues paid to OAPA are not tax deductible as charitable contributions for income tax purposes. However, a portion of your dues may be deductible as an ordinary and necessary business expense subject to restrictions imposed as a result of OAPA lobbying activities. OAPA estimates that the non-deductible portion of your dues - the portion allocated to lobbying - is seventy-five percent (75%).
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