2024 OPRA Public Entity Membership Application

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 2024 Membership Year. Revisions may affect the dues structure for following years.
• Please complete the following information accurately as possible to help us better serve you - Thank you!

Organization Information

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 Superintendent (if different from above)

First Name
Last Name
Title
Email

Billing Contact (This individual will receive all invoices from OPRA)

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:
 
If your Board still provides services, please list them here:
 
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

Public Entity Membership is designed specifically for Ohio's local county boards of developmental disabilities and regional Council of Governments (COG).
$1,000 - Public Entity Level 1
 This member will have access to Friday Calls, Weekly Friday 5 and other information that is not for members only. This member will also have access to monthly “partnership” meeting with the OPRA Team and members.
$3,000 - Public Entity Level 2
 In addition to Public Entity Level 1 member benefits this member will have access to the HR, Health, Day Array, Employment, ICF and Residential Waiver Committees (The chairs of the committees have the opportunity to declare any meeting as a “provider only” meeting if there is information being discussed that is crucial to OPRA policy decisions and/or strategies).
$10,000 - Public Entity Level 3
 This option gives you a Level 2 membership and allows you to offer a 1-year membership to (3) Providers in your county (the providers you select cannot be current members of OPRA). The Providers you select will have full access to all that OPRA provides including Advocacy, Information, Resources, and Technical Assistance.
Please select one of the Public Entity Levels below.
Membership Level
 * If selecting Public Entity Level 3, please contact OPRA to learn how to add your Providers to the OPRA Membership Roster.

Terms and Conditions

By signing the form below, the Organizational Representative understands that an OPRA Staff member may confirm subscriptions and inquire about any additional employee subscriptions. The Organizational Representative also consents to the organization’s listing as an OPRA Member on any/all published materials.
I certify that the information on this form is current, accurate, and complete.
Signature
Date ?
   - denotes required fields