OKLAHOMA INDEPENDENT PROVIDERS ASSOCIATION

MEMBERSHIP AGREEMENT

This Membership Agreement is entered into this ______ day of _____________________, 20___, by and
between Oklahoma Independent Providers Association, an Oklahoma Limited Liability Company,
and (Print or Type Name) _______________________________________, of _______________,
Oklahoma, (hereinafter “Provider”). Use this link to process your member payment
https://app.fluidpay.com/spp/OKIPA_Membership or https://okipa.org/ and click “Start Membership
Now.”

WHEREAS, Provider” has completed and submitted the required Credentialing Application and
Documents for Membership in Oklahoma Independent Providers Association, and has made full,
complete and accurate disclosure of all information required; and,
WHEREAS, the Credentials Committee and the Board of Directors of Oklahoma Independent
Providers Association have found Provider” to meet its general Membership requirements and have
approved Provider” for Membership in Oklahoma Independent Providers Association; and,
NOW THEREFORE, in consideration of the foregoing recitals and for other good and valuable
consideration, receipt of which is hereby acknowledged, the parties hereto agree as follows:
Provider” is hereby accepted as a Member in Oklahoma Independent Providers Association as set
forth and defined in the Policies and Guidelines and subject to the terms and provisions hereof.
Provider” hereby agrees to accept and comply with any and all requirements and obligations of
Membership as set forth in the Policies and Guidelines, as may be altered and/or amended from time to
time by Oklahoma Independent Providers Association, and such other policies, procedures and
guidelines as may be established by Oklahoma Independent Providers Association.
Oklahoma Independent Providers Association acknowledges receipt from the Provider” of the Annual
Membership fee of $_______. The Membership Period to which such fee shall apply shall be one
calendar year commencing the calendar year in which the Provider” becomes a member in Oklahoma
Independent Providers Association.
Oklahoma Independent Providers Association may terminate Membership of Provider” conferred
upon herewith in accordance with and in the manner set forth in the Policies and Guidelines, as may be
altered and/or amended from time to time by Oklahoma Independent Providers Association, and such
other policies, procedures and guidelines as may be established by Oklahoma Independent Providers
Association. Provider” may terminate Membership herein at any time by giving written notice to
Oklahoma Independent Providers Association of said termination.
WHEREOF, this Membership Agreement has been executed by the undersigned effective the date first
written above.