Membership Application

Join Oregon’s professional association for prehospital providers.

Name *

First

Last

Email *

Mobile Phone *

Work Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Which Agency or Department do you work for?

What is your level of medical training?

Which benefits interest you most?

Conferences with continuing education opportunities
Current events in Oregon EMS via newsletter
Certificated classes like PHTLS
Other

Agreement *

I agree to the terms below.

Membership in Oregon EMS Association will last for a term of one year. Membership entitles you to XXX.

1-year membership to Oregon EMS Association *

Price: $ 25.00

Payment may be made via secure credit card transaction below via Stripe, or you may mail a check payable to Oregon EMS Association, PO Box 1118, Hillsboro, Oregon, 97123. Membership will be pending until payment is received.

Stripe Credit Card

Card

Name on Card

If sending a check, please indicate the account holder's name & date check will be mailed