Community Organization
Statewide Organization
Member-at-Large
Turning Point Partner Community (please specify)
Community Name
Political
Business Economic
Health
Religious
Recreational
Communications
Education
Voluntary
Social Welfare/Non-Profit
Other (Please specify)
Other Stakeholder
Special Accommodations Needed?
No
Yes
If yes, specify:
NOTE: The registration fee this year is $40.00 or $60.00 at the door. After clicking the Submit button, you will be taken to a payment page, where you can pay via credit card to the Public Health Institute of Oklahoma. Or, you may write a check, money order, or agency purchase order payable to the Public Health Institute of Oklahoma, P.O. Box 60926 Oklahoma City, OK 73146-0926, fax: (405) 271-1225. Your registration will not be complete until you submit your payment.