2015 OTS Membership Form Admittance to the OTS membership is open to all Oregon-based health professionals involved in respiratory, critical care or sleep medicine. Membership is defined as active participation through at least one of the following activities and renewed annually (Jan 1 – Dec 31). Question Title * 1. Please enter your contact information: Name: * Employer: * Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Email Address: * Phone Number: Question Title * 2. Are you a current OTS member? Yes No Question Title * 3. Are you a current ATS member? Yes No Question Title * 4. The following are approved participation activities to claim OTS Membership. Check one or more boxes to qualify for 2013 membership. Further information will be provided to you on how to participate based upon your selection below: Hold an OTS Office or Committee Role Present at an American Lung Association in Oregon (ALAO) Educational Program Support the ALAO Advocacy Efforts Represent the ALAO in a Media Activity Participate in an ALAO Event Submit a Direct Donation to the ALAO Question Title * 5. Additional comments: Next
