Ohio Pain Initiative

:: Ohio Pain Initiative: New Member Application

Ohio Pain Initiative
555 Metro Place North
Suite 650
Dublin, Ohio 43017
P: (614) 763-PAIN (7246)
F: (614) 763-0050
E: ohiopain@ohiopaininitiative.org

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Join on-line right now using PayPal
Become a member by mail with our printable Membership Application (pdf)

Membership Level	Benefits
Friend - $20	Subscription to The Resource (OPI's official newsletter)
Individual - $50	Subscription to The Resource (OPI's official newsletter) + discounted registration for educational programs
Organization - $200	5 copies of The Resource (OPI's official newsletter), 5 coupons for discounted registration for educational programs, + recognition annually in The Resource.
Industry Silver - $1,000 Gold - $2,500 Platinum - $5,000 Diamond - $10,000	5 copies of The Resource (OPI's official newsletter), 5 coupons for discounted registration for educational programs, + recognition annually in The Resource.

Member Information


Name:

Title/Degrees:

Organization:

Address:

City:

State:

Zip:

Phone:

Fax:

email:

Subcommitte
Which subcommittee would you be willing to sit on? (Please select at least one)

		Standards/Professional Education

		Fundraising/Marketing

		Membership/Newsletter

		Public Education

All members are invited to attend the quarterly Board of Trustee meetings and are encouraged to volunteer for a subcommittee. The membership year is January 1 through December 31.