Annual Convention Attendee Registration

*The information collected on this form will be displayed on the event mobile app.

Name of Person Attending the Event *

Phone Number *

Email Address *

Address *

Address

City

State/Province

Zip/Postal

Organization *

Title *

Membership Type

Please Choose Your Membership Type *

Which Health Plan Member? *

Which Affiliate Member? *

Uncertain if your company is a member? Click here to verify your company membership.

Which Supporting Member? *

Which Supporting Premium Member? *

If an individual has already registered with the same member organization, the member complimentary registration may already be utilized.

If so, all additional Supporting member registrations will incur the Preferred Supporting member discounted registration fee.

Support Registration

Confirm Membership

I confirm that the membership selected is accurate. If you are unsure, please confirm by reviewing the list of members at the link above.

Health Plan Member Registration Type *

Affiliate and Affiliate Premium Registration Type *

Has Your Organization Already Registered As A Sponsor? *

Company Name Registered As Sponsor *

Additional Sponsor Opportunity Selected

Registration Type *

Table Guests

1. First Name

Last Name

Title

Email

Phone

2. First Name

Last Name

Title

Email

Phone

3. First Name

Last Name

Title

Email

Phone

4. First Name

Last Name

Title

Email

Phone

5. First Name

Last Name

Title

Email

Phone

6. First Name

Last Name

Title

Email

Phone

7. First Name

Last Name

Title

Email

Phone

Additional Registrants

Add Another? *

1. First Name *

1. Last Name *

1. Title *

1. Email Address *

Phone

Additional 1 Health Plan Amount *

Additional 1 Affiliate and Affiliate Premium Amount *

Amount *

Add Second? *

2. First Name *

2. Last Name *

2. Title *

2. Email Address *

Phone

Additional 2 Health Plan Amount *

Additional 2 Affiliate and Affiliate Premium Amount *

Amount *

Add Third? *

3. First Name *

3. Last Name *

3. Title *

3. Email Address *

Phone

Additional 3 Health Plan Amount *

Additional 3 Affiliate and Affiliate Premium Amount *

Amount *

Add Fourth? *

4. First Name *

4. Last Name *

4. Title *

4. Email Address *

Phone

Additional 4 Health Plan Amount *

Additional 4 Affiliate and Affiliate Premium Amount *

Amount *

Add Fifth? *

5. First Name *

5. Last Name *

5. Title *

5. Email Address *

Phone

Additional 5 Health Plan Amount *

Additional 5 Affiliate and Affiliate Premium Amount *

Amount *

Add Sixth? *

6. First Name *

6. Last Name *

6. Title *

6. Email Address *

Phone

Additional 6 Health Plan Amount *

Additional 6 Affiliate and Affiliate Premium Amount *

Amount *

Additional Needs

Dietary Needs: (Please note any allergies or dietary restrictions)

Pursuant to the Americans with Disabilities Act, do you require specific aids or services?

Details regarding aids or services requested

Payment

Registration Fee Amount

Payment Method *

Check (Mail to: OAHP, 20 E. Broad Street, Suite 701, Columbus, OH 43215. Your registration will not be processed until we receive payment.)

PayPal / Credit or Debit Card

All cancellations must be received in writing to the OAHP by September 1, 2024, less a $100 service charge to receive a refund and approval of cancellation. No cancellations will be accepted, or refunds issued after this date. Substitutions are accepted and encouraged.

Contract will not be processed without payment and contract authorization unless other arrangements have been made through OAHP.

By registering for the OAHP Convention & Trade Show, you give permission to OAHP to subscribe you to the regular email newsletter.

Captcha

Payment Notice

After clicking "Submit" below, you will be taken to PayPal to complete payment. On the PayPal screen, select "Pay with Debit or Credit Card" and continue the process. Your registration will be finalized when payment is completed through the PayPal platform.

*The information collected on this form will be displayed on the event mobile app.

Membership Type

Table Guests

Additional Registrants

Additional Needs

Payment

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