OKLAHOMA INDEPENDENT PROVIDERS ASSOCIATION
MEMBERSHIP AGREEMENT
This Membership Agreement is entered into this______day of_____________________
, 20___, by andvbetween 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 Membership application for
the Oklahoma Independent Providers Association, and has made full, complete and accurate
disclosure of all information required; 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.