Sign-Up

  1. Signup via the Online form (below); OR
  2. Download and fill-in either the MS/Word or PDF form then email or fax it back to us.
    1. MS Word 2010 Format
    2. MS Word 97-2003 Format
    3. Adobe PDF

Select your OUS Institution, or State Agency, or ORCPP Membership – then fill in the rest of the form as required. (Bold Fields Required)

OUS Institution
Oregon Agency
ORCPP Membership
Billing Contact Name
Billing Contact Phone
Billing Contact Email
Bill To Address, City, State, Zip
Billing Identifier (Automatically Assigned if Left Blank)
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Use this field to enter either your OUS Chart-Index information or your Agency PCA number or other internal billing identifier you want us to reference on your bill.
VCON Coordinator Name
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The VCON Coordinator is the person / group that is responsible for coordinating voice/video/virtual conferencing, training and support within your agency, institution or organization.
VCON Contact Phone
Audio Service Plan:
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All Audio Subscription services are a minimum commitment of the remaining months in the current fiscal year, plus one full fiscal year.
Video Service Plan:
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All Video Subscription services are a minimum commitment of the remaining months in the current fiscal year, plus one full fiscal year.
Authorization
Authorization

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