Associate Membership Application

Associate Membership Application
Associate membership in the Ohio Osteopathic Association is open to graduates of accredited schools of medicine and surgery or podiatric medicine and surgery, who are licensed to practice in Ohio and support the OOA mission and subscribe to its code of ethics. Associate members receive the same benefits as regular members. Such members may serve on OOA Committees; however they shall not have the privilege of serving as a voting member of the OOA House of Delegate or the right to hold an office.


First Name:
Last Name:
Business Name:
Business Address:
City:-> State Zip
Phone:	Fax:
Email:
Reason for seeking Associate Membership:
	MD
	DPM

Dues Amount

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