Individual CS Membership Application

Thank you for your organization's interest in becoming an OPHA member for 2020/21. Membership will end March 31, 2021. Please complete all applicable sections of the following form.

At the end of the membership cycle, your membership will automatically renew for another one-year term at a rate of $120, unless you provide notice to us of your intent to terminate your membership at least 30 days before your membership expires. Please contact membership@opha.on.ca for more information or to cancel your renewal.

Membership *

Individual CS - $ 20.00

As a charitable, non-profit organization, OPHA relies on the generous support of health enthusiasts like you. Your donation today helps us do more tomorrow. If you'd like to make a donation, please enter that amount here. Thank you for your support.

Total Amount

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

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Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Password

Confirm Password

Provide a password for the new account in both fields.

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Alcohol	Breast Feeding	Built Environment
Child and Youth	Chronic Disease Prevention	Communicable Diseases
Environmental Health	Food Security	Health Equity
Healthy Aging	Injury Prevention	Reproductive Health
Cannabis	Substance Misuse	Mental Health
Health Eating & Nutrition	Physical Activity	Health Promotion
Tobacco Control	Climate Change	Health System Transformation
Child Health	Oral Health	Social Determinants of Health
All of the Above

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