Parties

This Membership Agreement (“Agreement”) is entered into by and between East Cascades Works (“Fiscal Agent”), the Central Oregon Behavioral Health Consortium (“Consortium”) and [Member Name] (“Member”).

Please enter your information below.

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1. Name (Required.)

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2. Organization/Business Name (Required.)

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3. Title/Role (Required.)

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5. Phone (Required.)

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6. Address (Required.)

Below, please list the email addresses of anyone else at your organization who should be added to the COBHC email list:
Purpose

The purpose of this Agreement is to outline the terms and conditions of membership in the Consortium, which supports collaboration among behavioral health providers and partners.
Membership Categories and Eligibility
  • Individual Practitioner Membership: solo, licensed practitioner
  • Group Practice Membership: multi-provider practices or behavioral health departments
  • Public Benefit Membership: Group Practices that qualify as a COA Site, CMHP, or FQHC
  • Support Partner Membership: adjacent organizations (e.g., educational institutions, associations)
  • Student Intern Membership: students currently enrolled in an accredited behavioral health or related degree program who are completing practicum, internship, or clinical placement hours within the Central OR region
  • Affiliate Membership: behavioral health practitioners or organizations that qualify for an Individual Practitioner, Group Practice, or Public Benefit Membership and reside and practice outside the Central Oregon (Crook, Deschutes, and Jefferson counties) region, but within the East Cascades Works service area
Eligibility is subject to approval by the Fiscal Agent.

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12. I select the following membership level: (Required.)

You’ll enter payment info after the survey.
Dues and Payment Terms

Membership fees vary based on category. Payment must be received within 30 days of submission of this Agreement, otherwise this Agreement will be null and void. Fees are payable annually and are non-refundable unless otherwise specified by the Fiscal Agent.

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Term and Renewal

Membership begins on the date an application is submitted and any applicable membership dues are paid. Membership remains active for one (1) calendar year from the enrollment date and does not automatically renew. Members must reapply and, if applicable, remit membership dues to continue their membership. A renewal reminder will be provided approximately thirty (30) days prior to the expiration of the current membership term.
Member Obligations

Members agree to:
  • Participate in meetings or initiatives as requested
  • Adhere to professional standards and Consortium values
  • Notify the Consortium of changes in eligibility status
  • Support promotion of and participation in Consortium trainings and events
Independent Engagement

The Parties acknowledge and agree that any services or work performed by the Member shall not be governed by this Agreement but instead shall be subject to a separately negotiated and executed agreement. No obligations, rights, or compensation related to such services or work shall arise under this Agreement unless and until such a separate agreement is entered into by the Parties in writing.
Intellectual Property and Restrictions

The Member acknowledges that the Consortium’s name, services, and any materials produced by or for the Consortium shall remain the property of the Consortium and therefore must bear the shared branding of the Consortium.

No member shall:
  • Reproduce or use any materials produced by the Consortium or any of its members without consent by the originator
  • Remove identification, copyrights, or branding from any materials provided by the Consortium or its members
  • Receive compensation for any Consortium services without prior written consent from the Fiscal Agent
Termination

Either party may terminate with written notice. The Fiscal Agent may terminate for non-payment, misconduct, or loss of eligibility. Dues are non-refundable as a result of termination by either party, unless otherwise approved by the Fiscal Agent.
Member Consent

Members agree to hold the Fiscal Agent, the Consortium, its members, and affiliates harmless from any damage that may arise while participating in the Consortium.

Member agrees that this Agreement offers no guarantees of any kind. Members also agree and understand that their participation in the Consortium may involve risks and by signing this Agreement you assume those risks by your own will.
Information Sharing

Member hereby consents to the disclosure of their contact information to other registered members of the Consortium, EC Works, and subcontractors engaged by EC Works in connection with COBHC activities. Such information shall be used solely for purposes related to COBHC activities. Any disclosure of the Member’s contact information to entities outside the Consortium, EC Works, or its subcontractors shall require the Member’s prior written consent. Under no circumstances shall EC Works or its subcontractors sell, trade, or otherwise commercially exploit the Member’s contact information.
Amendments

The Fiscal Agent may amend this Agreement with 30 days’ notice to Members.
Governing Law

This Agreement is governed by the laws of the State of Oregon.
Authorization

I, the undersigned, hereby certify that I am duly authorized to enter into contract on behalf of my organization, and that by entering my name below, my organization agrees to be bound by the terms and conditions set forth herein.

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13. Member Signature (Required.)

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14. Date (Required.)

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Payment

On the next page you will be prompted to submit payment based on your selected membership level. If you are unable to pay using a credit card, you must contact kristyn@ecworks.org to request an invoice.

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