Oregon MGMA, State Affiliate

OMGMA On-Line Membership Renewal
Please complete the following information to process your Membership Renewal on-line.
Dues of $85.00 + $5.00 handling fee will be charged to your credit card.
 
* First name: * Last name:
* Clinic Name:
* Address:
Address2:
* City, State Zip:      
* Phone: Fax
* Email:    
Website: Would you like a link from OMGMA to your site? Yes No
Practice Ownership:

Physician Hospital Private
IPA Insurance Public
Other

Year Joined OMGMA: Year Joined MGMA:
# of FTE Physicians: # of Physician Assistants:
# of Nurse Practitioners: Practice Specialty:
Spouse's First Name:    
Fields marked with red * must be filled in.
  Now Accepting Credit Cards!