Individual Membership Application or Renewal
Thank you for your interest in becoming a member of The Brain Injury Association of Ohio. You are the backbone of our organization. If you have any questions or problems completing this form, or if you do not receive acknowledgement of your membership, please e-mail Emily Smith at
Please use this form for Regular, Professional, Student or Constituent Memberships.
Corporate Members, please complete a Corporate Membership Application or Renewal form.
Regular Membership - $40.00/year
Professional Membership $50.00/year
Student Membership $20.00/year
Constituent Membership - No charge to brain injury survivors, family members and caregivers
New Membership or Renewal
I am renewing my Membership
I am a new Member
Constituent Members - I am a...
Brain Injury Survivor
Other Family Member
I am not requesting a Constituent Membership
A check or money order was mailed to BIAOH, PO Box 21325, Columbus, OH 43221
Payment was made using PayPal (please note your name and "membership" in PayPal's special comments section)
I am requesting a Constituent Membership
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service