Membership Form

Payment

There are four categories of NHOPA membership: User, Health Professional, Individual, and Corporate. Only User members are allowed to vote on Association matters. All dues are tax deductible as a contribution to a 501(c)(3) organization.

$15.00 - Oxygen User Membership
$25.00 - Health Professional Membership
$50.00 - Individual Membership
$100.00 - Corporate Membership

Please submit this form online and mail a check for the appropriate fee to complete enrollment (Click here for a printable version.)

Make check payable to:

NHOPA
8618 Westwood Center Drive, Suite 210
Vienna, VA 22182-2222

Inquiries:

NHOPA Executive Office
8618 Westwood Center Drive, Suite 210
Vienna, VA 22182-2222
1-888-NHOPA-44

Member Information

Salutation:	Mr. Mrs. Ms.
First Name:
Last Name:
Address:
City:
State:
Zip:
Phone:
Email:

Optional Information

You are not required to provide this data but it will assist the Association in developing important information regarding the Association's members.

Your age:
How long have you been on supplementary oxygen based on a physician's prescription?	years, months
How many hours per day do you use oxygen?
Do you use stationary equipment?	Yes No
If so, which system(s) do you use?	Liquid     Concentrator
Do you use portable equipment?	Yes No
If so, which system(s) do you use?	POC (Portable Oxygen Concentrator)     Liquid tanks     Compressed gas tanks
What is your primary diagnosis warranting oxygen usage?
May we include your name and contact information in our user to user Information Exchange Directory?	Yes No
How did you hear about NHOPA?

The National Home Oxygen Patients Association was established in the late 1990's to give supplementary oxygen users the information necessary to lead productive lives. The Association is managed by a core group of oxygen users whose efforts are supported through additional volunteer work of nationally recognized physicians, equipment suppliers, and manufacturers, all of whom provide important resources to the Association. NHOPA is devoted exclusively to improving the lives of people across the country who require supplementary oxygen on a regular basis. You may contact us for assistance at ExecOffice@homeoxygen.org

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