Provider New Membership Application

Welcome to the Ohio Provider Resource Association!

We hope you enjoy your introductory membership rate and take full advantage of all the great benefits OPRA has to offer!
Reminders and Details:
 Ohio Provider Resource Association engages in lobbying, and under federal law, 10% of membership dues are not deductible as a business expense.
 OPRA’s Membership Year is from January 1 through December 31.
 The dues structure described herein is an introductory rate applicable solely to new members in the 2020 Membership Year. Revisions may affect the dues structure for following years.
 Upon completion of this form, an invoice will be emailed to you within 1-2 business days. If you have any questions regarding your OPRA Membership, please feel free to contact us at (614) 224-6772.

Organization Information

Organization Name
Main Phone

Physical Address

CHECK if Billing address and Physical address are the SAME

Billing Address

Please provide Billing Address ONLY if different from above.
CHECK if Billing address is DIFFERENT from Physical address

Your Contact Information

First Name
Last Name

Organization's CEO, Executive Director or Owner (if different from above)

First Name
Last Name

Billing Contact (if different from above)


Additional Organization Information

Please list all other names by which your organization is known and/or subsidiary entities which your organization owns that fall under this membership:
Total # Employees, including in all locations:
Please select all applicable services your organization provides: (use SHIFT, CONTROL or COMMAND to multi-select)
Approximately how many individuals do you serve a year?
Please choose the following counties you provide services in:
  All 88 Counties Adams Allen
  Ashland Ashtabula Athens
  Auglaize Belmont Brown
  Butler Carroll Champaign
  Clark Clermont Clinton
  Columbiana Coshocton Crawford
  Cuyahoga Darke Defiance
  Delaware Erie Fairfield
  Fayette Franklin Fulton
  Gallia Geauga Greene
  Guernsey Hamilton Hancock
  Hardin Harrison Henry
  Highland Hocking Holmes
  Huron Jackson Jefferson
  Knox Lake Lawerence
  Licking Logan Lorain
  Lucas Madison Mahoning
  Marion Medina Meigs
  Mercer Miami Monroe
  Montgomery Morgan Morrow
  Muskingum Noble Ottawa
  Paulding Perry Pickaway
  Pike Portage Preble
  Putnam Richland Ross
  Sandusky Scioto Seneca
  Shelby Stark Summit
  Trumbull Tuscarawas Union
  Van Wert Vinton Warren
  Washington Wayne Williams
  Wood Wyandot

Membership Dues

The dues structure described herein is applicable solely to the 2020 Introductory Membership Year. Revisions may affect the dues structure for following years.
Please record your organization's EGR for the next calendar year below.
In figuring your Estimated Gross Revenue, do NOT include revenue from fundraisers, United Way, gifts and donations. If your organization provides services to non-DD populations, you only need to include the revenue related to individuals with I/DD.
You may select one of the following payment plans for your dues payments.
You will be sent an invoice based on your payment choice below
 Your annual dues payment is due on or before March 15th.
 Your 1st semi-annual dues payment is due on or before March 15th. Your 2nd semi-annual dues amount will be invoiced by the end of June. A 5% discount is applied to the 2nd half dues amount if this payment plan is selected and the 1st payment is received by March 15.
 Your 1st quarterly dues payment us due on or before March 15th. Successive quarterly dues amounts will be invoiced by the end of each following quarter.


OPRA offers a special introductory rate for first year members. Second year OPRA members receive a 50% discount on the standard dues rate for OPRA membership. Third year and beyond, OPRA members pay the full standard dues rate for OPRA Membership. We encourage new OPRA members to talk with other members about the value of OPRA membership and how you can get the best return on your dues investment.

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