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Membership Application

Individual, Team or Institutional

“Together, celebrating the uniqueness of the middle level experience through advocacy and professional support”

Types of Membership:

Individual ($35) - Includes newsletter and member rates for all OMLA events.

Full-Time Student ($20) -  Includes newsletter and member rates for all OMLA events.

Team ($125) - Includes Principal and 4 team members, individual newsletters and member rates for all OMLA events for all team members.

Institutional ($250) - Includes principal and 11 team members, individual newsletters and member rates for all OMLA events for all staff members of the institution.

OMLA Membership Form

Date*

MM		/
DD		/
YYYY
School*
Street Address*
School Phone*
School Fax
District*
County
TYPE OF MEMBERSHIP (Please choose only one)*
 Individual 
 Full-Time Student 
 Team 
 Institutional 

MEMBER INFORMATION - Individual, Student or
Principal

Complete this section if you are signing up as an individual, student or principal.
If principal: Member of:
 OASSA 
 OESPA 
Name

First
Last
Position
E-Mail Address

MEMBER INFORMATION - Team Members

Complete this section if you are signing up as a team.
Enter the full name, position and e-mail address
for up to 5 persons.
Separate each member field by commas: e.g.: Mary
Smith, Project Coord., mary_smith@abc.com

MEMBER INFORMATION - Institutional

Complete this section if you are signing up as an institution.
Enter the full name, position and e-mail address
for up to 12 persons
Separate each member field by commas: e.g. Mary
Smith, Project Coord., mary_smith@abc.com
PAYMENT METHOD
 Please bill me at the above address. 
 I am printing this form and sending it along with a check payable to COSA/OMLA, addressed to OMLA, 707 13th Street, Suite 100, Salem, OR 97301-4035.  

Oregon Middle Level Association (OMLA)

Phone: (503) 581-3141 FAX: (503) 581-9840 Website: www.omla.net
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