Membership & Vendor Application

Are you a member or a vendor?

Member Vendor

Contact Information

Company Name

City (or cities) of Location

Number of Locations

Select a Level of Membership Support, (annual membership fee is based upon the select):

Platinum Support:
- $3,000.00 benefits,
- OMEPA Membership,
- website logos,
- free advertisement logos on all OMEPA publications as a platinum member,
- first choice of conference booth & electric with 30-minute presentation.

Gold Support:
- $1,500.00 benefits,
- OMEPA Membership,
- website logos,
- free conference booth & electric,
- conference advertisement support logos.

Silver Support:
- $750.00 benefits,
- OMEPA Membership,
- website logos,
- free conference booth & electric

Contact Name

Phone

Email

Product Lines (check all that apply)

CPAP & BiPAP Incontinence Supplies Oxygen Retail Wound Care Diabetic IV/PEN Pharmacy TENS/EMD Enteral Diabetic Shoes Mastectomy Power Mobility Ostomy Ventilation Bent Metal DME Orthotics / Prosthetics Complex Rehab Infusion Other

Membership & Vendor Application

Membership & Vendor Application

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