Membership Contract

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 may 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 of clients 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.

An AMHA Oregon Psychotherapists Guild Member must be an owner-member of AMHA-Oregon. Membership enrollment fees must be paid in full. All AMHA-Oregon application paperwork and proof of license and insurance must be complete and on file with the AMHA-Oregon administrative office prior to Guild participation.

The AMHA Oregon Psychotherapists Guild (which shall be referred to as the Guild) a marketing and public education project of the not-for-profit American Mental Health Alliance - Oregon and

________________________________________________________________, (who shall be referred to as the Guild Member) agree to the following:

1. The Guild agrees to develop and manage a comprehensive marketing effort to support the independent clinical practice of the Guild Member. This marketing effort may include;

a. Printed directories of all Guild Members who provide necessary materials prior to publication deadlines.

b. Web site listings which duplicate or expand upon the content of the printed directory and which has active consumer selection processes for Guild Member location, specialities, etc.

c. Announcements, advertisement, and organization of public presentations by Guild Members. (The number of Guild organized public presentations per Member may be limited by the Guild.)

d. A phone referral service.

e. Announcements of therapy groups and other specialized client services conducted by Guild Members on the web site and in a regularly published newsletter when the Member provides necessary information by publication deadlines.

f. Advertisements in print and electronic media, including newspapers, yellow pages, radio, etc.

g. The development of feature opportunities in print and electronic media, which highlight the Guild and Guild Member’s professional activities.

h. The development and maintenance of continuing communications with a wide referral base for Guild Members, including health professionals, legal professionals, human service agencies, schools, churches, businesses.

2. For the duration of this contract, the Guild may publish the names of the Members in good standing. The Guild Member may advertise his or her affiliation with the Guild using the Guild logo with the understanding that the Guild owns the logo and this contract is only a temporary lease.

3. In order to maintain the highest standards and thus protect all Guild Members, the Guild reserves the right to control quality whenever Guild membership is advertised. If the Guild determines that any Member’s materials are controversial, distasteful, of poor quality, unprofessional or inappropriate in any way the Guild may:

a. Refuse to allow the material to appear in the Directory or Web site,

b. Require that the Guild affiliation be removed from the material.

c. Refuse to include the material in Guild advertisements.

4. If the Guild’s decisions about advertising quality control adversely affect a significant or important aspect of the Guild Member’s practice, the Guild Member may terminate the contract with written notice and any advance monthly payments will be refunded.

5. Guild Membership is effective on the first day of the month after this Contract is signed and the Guild Member’s first share payment of two months participation cost has been received by AMHA-Oregon.

6.      Costs of Guild participation are $65 per month.

This contract runs for twelve (12) months from its effective date.

The total amount due under this contract is in no event less than $780.

7.      Guild Member costs of participation are billed in advance every two months.

Guild Member’s payments are due the first day of the month.
If bi-monthly payments are more than 15 days late, a re-billing fee of $10. will be charged.

If the Member’s account is 60 days late, the entire contract shall become due and payable at the monthly cost then applying and may be sent for collection.

The Guild Member agrees to pay all costs, expenses and attorney fees incurred by AMHA-Oregon in the event of any action for collection of this account.

8.      Given that this is an Alliance of professional colleagues, provision is made for withdrawal from this contract by a Guild Member in the event of hardship.

The AMHA-Oregon Board of Directors must be advised in writing of the hardship which places the Guild Member in the position of not being able to complete his/her contractual obligation. The Board may elect to accept or deny the Guild Member’s application for hardship withdrawal.
No Guild Member’s contract obligation which has come to be in arrears 60 days shall be eligible for hardship withdrawal.

9.       Because the Guild will be advertising a "no administrative services" discount, the Guild Member agrees to provide the following "no administrative services" discount:

When a client finds a therapist through the Guild, pays at the time of service and there is no requirement for statements that are suitable for an insurance company or other paperwork, the member will provide at least a 20% discount from his or her full fee for outpatient individual, couple, or family psychotherapy. If the client requires any paperwork other than receipts for payments the member may charge for the paperwork or may discontinue the discount.

10.      The Guild Member retains the right to make all of his or her fee setting policies excluding the "no administration" discount. This includes the right to offer greater discounts, to provide a sliding scale, to charge full fee for group therapy and to charge full fees for services other than outpatient therapy.

11.      If the Guild ceases marketing services any advance payments for the Guild operations contract year will be refunded.

12.      The Guild Member agrees to provide prior to reasonable deadlines established by the Guild:

a. Proof of license according to AMHA-Oregon procedures.

b. Proof of professional liability insurance indicating 1 million per occurrence and 3 million aggregate limits of coverage.

c. A quality professional portrait photograph meeting the Guild’s standards.

d. A description of his/her practice that meets the quality, editorial review and format standards set for Guild Directories.

13.      The Guild Member agrees to notify the AMHA Oregon Psychotherapist’s Guild immediately of actual or threatened loss, suspension, or revocation of the Guild Member’s professional license.

14.      The Guild or the Guild Member may terminate this contract upon written notice for reasons of deceptive advertising, unethical advertising, or conduct of a personal or professional nature that may reflect poorly on the other party.

15.      Membership in AMHA Oregon Psychotherapist’s Guild does not create or imply a partnership between or among the Guild Members. Both AMHA Oregon Psychotherapists Guild and the Guild Member agree that they will not represent or imply that a partnership exists. AMHA Oregon Psychotherapist’s Guild is a membership organization of independent professionals organized solely for the purposes stated in herein.

Print Member's Name: ________________________________________

Member's Signature: __________________________________________

Date: ________________________

President, AMHA-Oregon: ___________________________________________

Effective Date of Guild Membership: ___________________

The addresses of the parties to this contract are:

Print Member’s Address:

___________________________________________________

___________________________________________________

___________________________________________________

AMHA Oregon Psychotherapist Guild

PO Box 4075

Portland, OR 97208-4075