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Provider Membership Renewal Application
Welcome to the Ohio Provider Resource Association!
Thank you for renewing your OPRA Membership. 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 applicable solely to 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
Type
choose one
For Profit
Non-Profit
Independent Provider
Organization Name
Website
Main Phone
Physical Address
CHECK if Billing address and Physical address are the SAME
Address
City
State
Zip
Billing Address
Please provide Billing Address
ONLY if different from above.
CHECK if Billing address is DIFFERENT from Physical address
Address
City
State
Zip
Your Contact Information
First Name
Last Name
Title
Email
Organization's CEO, Executive Director or Owner (if different from above)
First Name
Last Name
Title
Email
Billing Contact (if different from above)
First
Last
Title
Email
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)
select all that apply
Adult Day Support
Behavioral Health Care (OMHAS)
Early Intervention Services
HCBS Waiver Career Planning
HCBS Waiver Group Employment Supports
HCBS Waiver Individual Employment Supports
HCBS Waiver Nursing
HCBS Community Respite
Home Health Care/Hospice
HPC
ICF/IDD
Medicaid Funded Therapies
Multi-System Youth Services
NMT
OOD Vendor
Remote Support
Shared Living
Vocational Habilitation
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
Annual
Your annual dues payment is due on or before March 15th.
Semi-Annual
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.
Quarterly
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.
A LOOK AHEAD
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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