STATEMENT OF MISSION

American Mental Health Alliance-Oregon, (AMHA-Oregon) is a non profit organization of licensed mental health practitioners incorporated February 2, 1996, under the laws of the State of Oregon.

AMHA-Oregon intends to operate a Guild of independent professionals who market ethical professional services and provide public education concerning the necessary confidentiality, integrity and quality of clinical relationships.

AMHA-Oregon intends to operate a statewide referral service.

AMHA-Oregon intends to create contractual relationships with employee or other groups for the provision of mental health and substance abuse treatment services. AMHA-Oregon intends to create such contracts between this self-managing Alliance and groups without the participation of costly and intrusive outside parties whose interests may conflict with the ethical and professional responsibilities of our various mental health disciplines.

AMHA-Oregon intends to respect and preserve the professional integrity of its members, and the confidentiality of client-therapist relationships.

AMHA-Oregon is a member chapter of the national American Mental Health Alliance organization AMHA-USA. AMHA-Oregon intends to participate with the national organization and with AMHA chapters in other states to develop and continually improve programs for delivery of high quality mental and behavioral health services.

BENEFITS AND LIMITATIONS OF MEMBERSHIP

Members of AMHA-Oregon agree to support the Mission of the AMHA-Oregon and agree to participate collaboratively in the creation of AMHA-Oregon. AMHA-Oregon is incorporated as a non profit mutual benefit corporation in the State of Oregon. As such, no interest or dividends will accrue to members of the organization, or to any other parties. All fully enrolled members will be participants in a state-wide, nationally and locally advertised referral service.

MEMBERSHIP FEES and REQUIREMENTS

At this writing, the only funds available to AMHA-Oregon are the membership enrollment fees, member dues and Oregon Psychotherapists Guild participation fees. These funds are to be used strictly for the purposes of AMHA-Oregon development and operation.

Membership enrollment fees are non-refundable and non-transferable.

From April 1, 1999, through March 31, 2000, full payment of six hundred dollars ($600) is required in order to be enrolled as an AMHA-OR Member. Annual dues of $100 will be assessed to continue active membership.

Full enrollment requires: (1) completion of a Professional Information Questionnaire, (2) Proofs of licensure and malpractice insurance coverage (3) acceptance by AMHA-Oregon’s Board of Directors of those credentials.

AMHA-OR membership is required in order to become a participating professional in the AMHA Oregon Psychotherapists Guild. Guild participants will enroll by a separate participation contract and their annual AMHA-OR membership dues will be included in their payment of Guild Membership contract fees. Guild members will participate in a variety of public information and practice development activities.

AMHA-Oregon members accept the risks of operating in a competitive business environment, such that neither the success of the entire AMHA-Oregon nor the success of any individual member is in any way promised or guaranteed by AMHA-Oregon membership. Rather, membership provides the opportunity to participate as an independent practitioner building your ethical clinical practice and as an independent sub-contractor to contracts entered into by the organization. Fee-setting and other operational decisions will be determined in keeping with the Policies and Bylaws of AMHA-Oregon, to be set forth separately.

Those entering Membership in AMHA-Oregon are advised that:

• management of AMHA-Oregon is in the hands of an elected Board of Directors, there are member volunteers organized as Committees working with the elected Board;
• membership enrollment fees and dues will be used for AMHA-Oregon development operations and are not refundable;
• in the future the Board of Directors may elect to increase or decrease the membership enrollment fee and, if it is decreased, no refunds will be paid;
• in the future the elected Board of Directors and/or AMHA-Oregon members might vote to increase dues or to levy assessments to be paid by all members and all members would be bound to abide by a decision to pay such dues or assessments in order to retain their memberships;
• AMHA-Oregon expects to accept some degree of financial risk when contracts are made with employers and others to provide services, and that such financial risk may be shared by AMHA-Oregon members; (AMHA-USA and AMHA-Oregon are working to minimize risk by their design of professional member reimbursement programs and by obtaining insurance and re-insurance coverages.)
• in the planning and provision of services each AMHA-Oregon member will be bound by the ethical principles adopted by the licensing board which regulates his or her profession as well as the laws of the State of Oregon;

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I understand that by signing this Disclosure Statement I agree to support the AMHA-OR mission, and to accept the benefits and limitations set forth herein.

I understand that I must submit the following for review and acceptance by AMHA-Oregon's Membership committee to complete my AMHA-Oregon membership enrollment:

(1) an application statement concerning my qualifications and training,

(2) proof of my current licensure as an Oregon mental health professional,

(3) proof of my current malpractice insurance coverage,

(4) my $600 initial membership fee must be paid in full.

Signature _______________________________________________________

Month/Date/Year _____________________________