diff --git a/src/registrar/templates/portfolio_member_permissions.html b/src/registrar/templates/portfolio_member_permissions.html
index 02d120360..ca816ee2d 100644
--- a/src/registrar/templates/portfolio_member_permissions.html
+++ b/src/registrar/templates/portfolio_member_permissions.html
@@ -1,4 +1,145 @@
 {% extends 'portfolio_base.html' %}
+{% load static url_helpers %}
+{% load field_helpers %}
+
+{% block title %}Organization member{% endblock %}
+
+{% block wrapper_class %}
+  {{ block.super }} dashboard--grey-1
+{% endblock %}
+
+{% block portfolio_content %}
+
+<!-- Form mesages -->
+{% include "includes/form_errors.html" with form=form %}
+{% block messages %}
+  {% include "includes/form_messages.html" %}
+{% endblock messages%}
+
+<!-- Navigation breadcrumbs -->
+<nav class="usa-breadcrumb padding-top-0" aria-label="Domain request breadcrumb">
+  <ol class="usa-breadcrumb__list">
+    <li class="usa-breadcrumb__list-item">
+      <a href="{% url 'members' %}" class="usa-breadcrumb__link"><span>Members</span></a>
+    </li>
+    <li class="usa-breadcrumb__list-item">
+      <a href="{% url 'member' pk=member.pk %}" class="usa-breadcrumb__link"><span>Manage member</span></a>
+    </li>
+    {% comment %} Manage members {% endcomment %}
+    <li class="usa-breadcrumb__list-item usa-current" aria-current="page">
+      <span>Member access and permissions</span>
+    </li>
+  </ol>
+</nav>
+
+<!-- Page header -->
+{% block new_member_header %}
+<h1>Member access and permissions</h1>
+{% endblock new_member_header %}
+
+{% include "includes/required_fields.html" %}
+
+<form class="usa-form usa-form--large" method="post" id="member_form" novalidate>
+  {% csrf_token %}
+  <fieldset class="usa-fieldset margin-top-2">
+    <legend>
+      <h2>Member email</h2>
+    </legend>
+    {% comment %} TODO should default to name {% endcomment %}
+    <p>
+      {% if member %}
+        {{ member.email }}
+      {% elif invitation %}
+        {{ invitation.email }}
+      {% endif %}
+    </p>
+    <!-- Member email -->
+  </fieldset>
+
+<!-- Member access radio buttons (Toggles other sections) -->
+<fieldset class="usa-fieldset margin-top-2">
+  <legend>
+    <h2>Member Access</h2>
+  </legend>
+
+  <em>Select the level of access for this member. <abbr class="usa-hint usa-hint--required" title="required">*</abbr></em>
+
+  {% with group_classes="usa-form-editable usa-form-editable--no-border padding-top-0" %}
+  <div class="usa-radio">
+    {% for radio in form.member_access_level %}
+        {{ radio.tag }}
+        <label class="usa-radio__label usa-legend" for="{{ radio.id_for_label }}">
+          {{ radio.choice_label }}
+          <p class="margin-0 margin-top-2">
+          {% if radio.choice_label == "Admin Access" %}
+              Grants this member access to the organization-wide information on domains, domain requests, and members. Domain management can be assigned separately.
+          {% else %}
+              Grants this member access to the organization.  They can be given extra permissions to view all organization domain requests and submit domain requests on behalf of the organization. Basic access members can’t view all members of an organization or manage them. Domain management can be assigned separately.
+          {% endif %}
+        </p>
+      </label>
+    {% endfor %}
+  </div>
+  {% endwith %}
+
+</fieldset>
+
+<!-- Admin access form -->
+<div id="member-admin-permissions" class="margin-top-2">
+    <h2>Admin access permissions</h2>
+    <p>Member permissions available for admin-level acccess.</p>
+
+    <h3 class="summary-item__title
+    text-primary-dark
+    margin-bottom-0">Organization domain requests</h3>
+    {% with group_classes="usa-form-editable usa-form-editable--no-border padding-top-0" %}
+      {% input_with_errors form.admin_org_domain_request_permissions %}
+    {% endwith %}
+
+    <h3 class="summary-item__title
+    text-primary-dark
+    margin-bottom-0
+    margin-top-3">Organization members</h3>
+    {% with group_classes="usa-form-editable usa-form-editable--no-border padding-top-0" %}
+      {% input_with_errors form.admin_org_members_permissions %}
+    {% endwith %}
+  </div>
+
+  <!-- Basic access form -->
+  <div id="member-basic-permissions" class="margin-top-2">
+      <h2>Basic member permissions</h2>
+      <p>Member permissions available for basic-level acccess.</p>
+
+      <h3 class="margin-bottom-0">Organization domain requests</h3>
+      {% with group_classes="usa-form-editable usa-form-editable--no-border padding-top-0" %}
+        {% input_with_errors form.basic_org_domain_request_permissions %}
+      {% endwith %}
+  </div>
+
+  <!-- Submit/cancel buttons -->
+  <div class="margin-top-3">
+    <a
+      type="button"
+      href="{% url 'members' %}"
+      class="usa-button usa-button--outline"
+      name="btn-cancel-click"
+      aria-label="Cancel adding new member"
+    >Cancel
+  </a>
+    <a
+      id="invite_member_trigger"
+      href="#invite-member-modal"
+      class="usa-button usa-button--outline margin-top-1 display-none"
+      aria-controls="invite-member-modal"
+      data-open-modal
+      >Trigger invite member modal</a>
+      <button id="invite_new_member_submit" type="submit" class="usa-button">Invite Member</button>
+  </div>
+</form>
+
+{% endblock portfolio_content%}
+
+{% comment %} {% extends 'portfolio_base.html' %}
 {% load static field_helpers%}
 
 {% block title %}Organization member {% endblock %}
@@ -39,4 +180,4 @@
 
     </div>
 </div>
-{% endblock %}
+{% endblock %} {% endcomment %}