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MEMBERSHIP – become a member

To become a member of Oral Health Kansas, Inc., fill out and submit the form below or click here to download the Membership Application form. To complete the membership process, you will also need to fill out and return a Membership Agreement form. Click here to download the Membership Agreement form.

Types of Membership:

1. Sustaining Member (Above $500): Consider becoming a member by making an additional gift to Oral Health Kansas to support us in achieving our mission.
2. Corporate Member ($500): Open to for-profit entities, corporations, businesses, consultants, vendors or institutions that support oral health issues or provide oral health services.
3. Associate Member ($100): Open to not-for-profit or public entities or organizations that support oral health issues or provide oral health services.
4. Individual Member ($25): Open to any individual who is interested in oral health issues (ex. individual dentists or hygienists, consumers, other interested parties).

MEMBERSHIP APPLICATION
*Indicates required field

* Type:	Sustaining (Gift above $500) Corporate ($500 per year) Associate ($100 per year) Individual ($25 per year)
Name:	*
Organization:
Address:	*
City:	*
State:	*
Zip:	*
Phone:	*
Fax:
E-mail:	*
Comments:	Add me to your e-mail/mailing list!
Security:	P T Y U M O L E O H K S J W R B	(Click the button at the left that exactly matches the letters above.)*

Questions:
Oral Health Kansas, Inc.
800 SW Jackson St., Ste. 1120
Topeka, KS 66612
Phone: 785.235.6039
Fax: 785.233.5564

Click here to send us an email.