Annual Membership Registration Form

Annual Membership Registration Form

Complete the form below to sign up for our association membership.
Greetings!

We are excited for the opportunity to serve you as a member of the Oregon Broadband Association. To express your interest in joining and to facilitate a smooth onboarding/renewal process, we kindly ask you to fill out the provided form. This form not only indicates your intent to join but also includes additional questions that will help kickstart the directory publishing process efficiently. Please know that Service Provider memberships have varying dues amounts. We will reach out to you to discuss that information.

Your participation is invaluable to us, and I encourage you to reach out to me at any time if you have questions or need assistance. We appreciate your commitment to enhancing broadband access in Oregon and look forward to welcoming you (or welcoming you back) to our community.

Warm regards,
Mandy Jundt
Full Name of Person Submitting this Form*

First NameLast Name
Your Title or Position*
Email*
example@example.com
Phone Number*
Company Name*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please Select Your Membership Level (Please see the associate benefits offered below)*

ILEC or CLEC (Dues vary based on size)Premier Associate Membership ($1,000/year); includes your color logo in the directoryAssociate Membership ($375/year)
Approximate Date of Company Formation*

MonthDayYear
Company Website*
This will be published in the directory.
Name of Representative for Directory*
This will be published in the directory.
Title of Representative for Directory*
This will be published in the directory.
Email of Representative for Directory*
example@example.com
Phone Number for Principal or Representative for Directory*
Please enter a valid phone number.
Additional Company Representatives to Publish
Limited to up to three contacts total. Include name, title and phone number in order to be included.
Name of Event Coordinator to Receive OBA Communications
Email of Event Coordinator to Receive OBA Communications
Please enter the geographic area your company serves.*
This will be published in the directory. Examples: Oregon, Washington, PNW, Nationwide, Global, etc.
Please enter a product or service description for your company. *
This will be published in the directory.
Would you like to include your color logo next to your company name in the directory? Make sure you upload your logo at the end of this form.*

Yes and I understand I will be billed $25 for this.No, thank you.I am a CLEC, ILEC or a Premier Associate member and this is included for me.
Would you like to place an advertisement in the directory?*

Yes, contact me for details.No, thank you.I'm not sure. Please reach out to me to discuss my options.
How would you like to pay for your membership?*

I will mail a CHECK. An Intuit Quickbooks invoice will be emailed to you after your membership is processed. This is a manual procedure, therefore you will not receive an invoice automatically. We appreciate your patience as we process each submission!I would like to pay via CREDIT CARD. An Intuit Quickbooks invoice will be emailed to you after your membership is processed. This is a manual procedure, therefore you will not receive an invoice automatically. We appreciate your patience as we process each submission! Please note card payments will include an additional 3% processing fee.
What is the best email address to mail your invoice to?*
example@example.com
Please upload a high resolution logo for your company.

PNG, JPEG formats preferred.
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Do you have any questions or comments for the coordinator? Please email Mandy at mjundt@oba-telecom.org.
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Annual Membership Registration Form

Do you have any questions or comments for the coordinator? Please email Mandy at mjundt@oba-telecom.org.