Oregon MIH Coalition Membership Form

Oregon MIH Coalition

Membership Form

Please complete the form below to confirm your information for the Oregon MIH Coalition distribution list and stay up to date on meetings, trainings, activities, and more. All members are asked to complete this form upon joining and again at the start of each calendar year.

If you have questions, please contact Sabrina Ballew, ORMIHC Chair, at sabrinab@mercyflights.com.

Contact Information

First and Last Name*

Email Address*

Phone Number*

Secondary Email Address (optional)

Secondary Phone Number (optional)

Organization Information

Affiliation*

List the organization/agency you work or volunteer with:

Current Role*

List your current role with your organization/agency:

If "Other" selected, please describe:

Service Area*

Where does you/your agency work or provide services?

Membership Information

Two membership types are currently available:

Full Membership grants the individual:

Voting rights on Coalition business;
Access to the Member Resource Library, which includes Coalition-developed documents, guidance, data, and more;
Ability to participate in workgroups or be elected as a board member;
Priority access to sponsored trainings;
Use of the ORMIHC logo/member badge

Dues are $30 per person per calendar year.

Affiliate Membership is a dues-free way through which passive participants can stay up to date with Coalition activities and learn more about the organization. Affiliate members receive meeting invitations and other Coalition updates and communications and will be granted access to members-only resources, though they do not have voting privileges or the ability to join workgroups or the board. Affiliate members cannot be currently affiliated with an existing MIH/CP program, and must be approved on a case-by-case basis by the Board.

If you would simply like to be added to our distribution list, please select this option. You will receive updates and communications from the ORMIHC, though will not receive any benefits of coalition membership.

Select Membership Type:*

Select

What ORMIHC activities most interest you?

Select all that apply, or share other ideas in the next question below.

Staying up to date on MIH policies and practices in Oregon

Accessing guidance, data, and other resources

Identifying funding opportunities

Assistance with developing or maintaining an MIH program

Accessing training and continuing education

Networking and collaboration with other members

Why else are you interested in the ORMIHC? What do you hope the ORMIHC can do to support you, your agency, or MIH at large?

Do you have any feedback or questions for us, or other information you'd like to share?

Send me a copy of my responses

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