Membership Application for BIA-OK

Brain Injury Alliance of Oklahoma
3015 E. Skelly Dr.
Tulsa, OK 74105

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Tulsa Area: 918-789-0406
Oklahoma City Area: 405-928-1647
fax: 918-712-9019

To establish or renew your membership with the Brain Injury Alliance of Oklahoma and receive our newsletters, please click on the button below. Your membership helps us in carrying out the goals and mission statement of BIA-OK.

NOTE FROM THE PRESIDENT:
The Brain Injury Alliance of Oklahoma is pleased to announce the 1st Annual Phantom Fund Drive as a part of March’s Brain Injury Awareness Month! The theme this year is “Brain Injury- Oklahoma, What Can You Do??" The drive will begin March 1st and run throughout the month until March 31st.

If you wish to print and mail your Membership/Sponsorship form, please click here to download a copy of the form.

Click here to see a list of the many benefits of being a Member or Sponsor.

The mission of the Brain Injury Alliance of Oklahoma is to create a better future through brain injury prevention, research, education and advocacy.

We encourage you to help raise money for brain injuries in the state of Oklahoma by becoming a member, a sponsor, a corporate sponsorship, or you can make a donation! There are many ways you can help:

Please choose an option below:

Type of Memberships:

____ Individual Professional $75

____ Individual or family $35

____ Survivor* $5 (to cover postage)

____ Courtesy Complimentary- any person or family with a brain injury who cannot afford the basic fee.

 

Type of Sponsorships:

____ Gold Corporate Sponsor $2,000

____ Silver Corporate Sponsor $1,000

____ Bronze Corporate Sponsor $500

 

$_____Donation for, or_____ in Memoriam of: ______________________________________________________.


You can pay for your Membership or Sponsorship by PayPal to join or to donate any amount to us by clicking the button below:


Any person with a brain injury and/or family who cannot afford the basic fee is welcome as members.

To request a waived membership, please email us at:
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Your membership funds assist us in carrying out the goals of the Brain Injury Alliance of Oklahoma.

The Brain Injury Alliance of Oklahoma is a 501 (c) (3) Registered Corporation,
and donations are tax-deductible to the extent allowed by law.