Clone of Annual Membership Registration Form

2026 OBA Annual Membership Registration Form

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

We’re excited to welcome you as a member of the Oregon Broadband Association! To confirm your interest in joining, please complete this form. It not only signals your intent to join but also provides details we need to include your organization in our member directory.

Please note that Broadband Service Provider memberships (telcos, ISPs, etc.) have varying dues amounts. For those members, we will contact you directly to review and confirm your specific dues amount and may ask a few more questions.

Your participation is invaluable to our mission of advancing broadband access across Oregon. If you have any questions or need assistance, please don’t hesitate to reach out to me at any time. We appreciate your commitment and look forward to welcoming you—or welcoming you back—to our community!

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

First NameLast Name
Your Title or Position*
Email*
example@example.com
Company Information
Company Name*
Company Website*
This will be published in the directory.
Company Phone Number
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please enter a short, but detailed product or service description for your company. *
This will be published in the directory.
Please enter the geographic area your company serves.*
This will be published in the directory. Examples: Oregon, Washington, PNW, Nationwide, Global, etc.
Are you interested in placing an advertisement in the directory? Premier Associate members receive a 50% discount on advertising opportunities in the directory, newsletter, promotional emails or the website.*

Yes, contact me for details.No, thank you.I'm not sure. Please reach out to me to discuss my options.
Membership Level
Please Select Your Membership Level (Please see the upgraded premier benefits offered below)*

Premier Associate Membership ($1,000/year); includes your color logo in the directoryAssociate Membership ($375/year)For returning members: Renew me at the same level as last year.ILEC/CLEC/WISP or other Broadband Service Provider
Directory Information
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, if so. Logos are included for Premier Associate members.*

Yes and I understand I will be billed $25 for this.I am a Premier Associate member and this is included for me.No, thank you.
Name of Representative 1 for Directory*
This will be published in the directory.
Title of Representative 1 for Directory*
This will be published in the directory.
Email of Representative 1 for Directory*
example@example.com
Phone Number for Representative 1 for Directory*
Please enter a valid phone number.
Would you like to add additional representatives or contacts in the directory?*

YesNo
Name of 2nd Representative for Directory
This will be published in the directory.
Title of 2nd Representative for Directory
This will be published in the directory.
Email of 2nd Representative for Directory
example@example.com
Phone Number for 2nd Representative for Directory
Please enter a valid phone number.
Name of 3rd Representative for Directory
This will be published in the directory.
Title of 3rd Representative for Directory
This will be published in the directory.
Email of 3rd Representative for Directory
example@example.com
Phone Number for 3rd Representative for Directory
Please enter a valid phone number.
Name of 4th Representative for Directory
This will be published in the directory.
Title of 4th Representative for Directory
This will be published in the directory.
Email of 4th Representative for Directory
example@example.com
Phone Number for 4th Representative for Directory
Please enter a valid phone number.
Name of 5th Representative for Directory
This will be published in the directory.
Title of 5th Representative for Directory
This will be published in the directory.
Email of 5th Representative for Directory
example@example.com
Phone Number for 5th Representative for Directory
Please enter a valid phone number.
Communication

In addition to the representatives listed above, please let us know who else should receive our news and updates.
Does your company have a dedicated Event Coordinator that you'd like to receive OBA communications? This is not published automatically in the directory and is used for internal purposes.*

YesNo
Event Coordinator Name

First NameLast Name
Email of Event Coordinator to Receive OBA Communications
example@example.com
Does your company have a dedicated Marketing Contact that you'd like to receive OBA communications? This is not published automatically in the directory and is used for internal purposes.*

YesNo
Marketing Contact Name

First NameLast Name
Email of Marketing Contact to Receive OBA Communications
example@example.com
Payment & Processing

As a small not-for-profit with only two FTEs, we utilize Quickbooks Online for our accounting services and therefore we manually process accounts receivables and sometimes do this in batches once or twice a week. Due to this, there may be a number of days in between your submission and receiving your invoice for payment. We appreciate your patience as we work to process each submission! If you have questions or aren't certain your form was submitted, simply reach out to me and I am happy to help!
How would you like to pay for your membership?*

I will mail a CHECK. Note: An Intuit Quickbooks invoice will be emailed directly to you after your membership form is processed!I would like to pay via CREDIT CARD. An Intuit Quickbooks invoice will be emailed directly to you after your membership form is processed. Please note card payments will include an additional 3% processing fee.
What is the best email to send your invoice to; in case you have a dedicated company AP email? Otherwise, enter your email, if you pay your own invoices.*
example@example.com
Please upload a high resolution logo for your company to use in the directory and for signage.

PNG, JPEG formats preferred.
Cancelof
Have any questions or comments? Please email me at mjundt@oba-telecom.org!
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2026 OBA Annual Membership Registration Form

Company Information

Membership Level

Directory Information

Communication

Payment & Processing