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Membership
OYS Membership Application
First name
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Last name
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Birthdate (Month and Day Only)
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Email
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Phone
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Multi-line address
Country/Region
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Address
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City
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Zip / Postal code
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Country of Residence
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Membership Type
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Membership
Volunteer
What specific skill(s) you will bring to the organization? (Choose Any Two)
*
Medical
Education
Fund Raising (Events & Grant Writing)
Legal (Editing & Compliance)
How did you hear about us?
*
Why are you interested in joining our association?
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Do you have any special skills or interests you would like to contribute as a member?
*
Any other comments or questions?
*
Membership Dues
*
Yearly Payment
$200
Quarterly Payment
$50
Monthly
$17
Declaration: I certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that membership approval is at the discretion of the association and may be subject to review.
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