Close login


 Remember Me
Forgot Your Password?

Member Application Form 

Please note any or all of the information submitted may require verification by OHA staff.
 
Category of membership desired (please click one):



Country (if not Canada)
Telephone
Fax
Web site
Courier address
   
Current executive official (i.e., Chief Executive Officer, Executive Director)
Name
Title
Telephone
Fax
Courier address
City
Province
Postal Code
Country (if not Canada)
   
Current board chair
Name
Telephone
Fax
E-mail
Courier address
City
Province
Postal Code
Country (if not Canada)
   
Application contact (if not current executive official)
Name
Title
Telephone
Fax
Courier address
City
Province
Postal Code
Country (if not Canada)
   
Billing contact
Name
Telephone
Fax
E-mail
Courier address
City
Province
Postal Code
Country (if not Canada)
   
Corporate information
Date of incorporation
What is the principal legislation under which your organization operates?
Does your organization participate in health care delivery in Ontario?
Does your organization participate in health care delivery outside of Ontario?
If so, where?
   
Specify the mission and operations of your organization, and specifically, how it relates to health care delivery
How many employees does your organization employ?
What is the primary source of funding for your operations?
Has your organization applied for membership with the OHA in the past?
If yes, please indicate the reason for re-applying for membership with the OHA
If you are approved as a member of the OHA, do you intend to seek membership with the Hospitals of Ontario Pension Plan (HOOPP)?
   
Please indicate other circumstances helpful in the review of your application (for example, application results from creation of new organization employing former hospital employees)
   
Please indicate a preferred date when you wish your membership with the OHA to be effective
(Note: if no date specified, membership will be effective the day the OHA Board of Directors approves an application)
   
Interest in OHA membership
  
To help us understand and respond to our membership, your answers to the following questions are appreciated:
 
Please indicate your reasons for becoming a member of the OHA (click those that apply):
Formal affiliation with the OHA
Participation with the Hospitals of Ontario Pension Plan (HOOPP)
Reduced rates on OHA’s professional development programs
Reduced rates on OHA’s conferences and annual convention (OHA HealthAchieve)
Weekly OHA communication, Executive Report
Access to OHA sponsored group benefits:
Hospitals of Ontario Disability Income Plan (HOODIP)
Hospitals of Ontario Group Life Insurance Plan (HOOGLIP)
Hospitals of Ontario Voluntary Life Insurance Plan (HOOVLIP)
   
After having reviewed the OHA’s membership benefits, please indicate how the OHA’s services could be enhanced to meet your organization’s needs
 
   
Please indicate if your organization would be interested in participating in occasional member surveys or studies, where appropriate?
   
Please indicate if you would like to receive period information regarding the OHA’s educational programs, conference and convention services?
   
   
 
   
   

Skip navigation links
About Us
News
Current Issues
Education
Leadership
Services
Knowledge Centre