World Chiropractic Alliance Membership Enrollment Form
World Chiropractic Alliance Membership
Yes! I want to support subluxation-based chiropractic by joining the World Chiropractic Alliance. By doing so, I am helping achieve the goal of a subluxation-free world through a vision of worldwide wellness.
Category (check one) [ ] Doctor of chiropractic within the United States: $99 per quarter or $396 per year.
[ ] Doctor of chiropractic outside Canada and the United States: U.S. $99 semi-annually or U.S.$198 per year.
[ ] Chiropractic student: $30 (a one-time charge that covers membership dues while in chiropractic college and for 12 months following graduation or until licensure has been granted, whichever occurs first.)Graduation date ______________________________________. [ ] Full time faculty in a chiropractic college: $99 per year
Signature of Card Holder: ________________________________________________________
I authorize the World Chiropractic Alliance to charge the credit card listed above automatically for recurring quarterly, semi-annual or annual membership payments and renewals until I instruct the WCA, in writing, to terminate my membership.
Please print this form, fill it out completely, and send it with payment (in $US) — or credit card information — to: World Chiropractic Alliance, 2683 Via de La Valle Suite G 629 Del Mar, CA 92014
OR fax with credit card information to: 1-866-789-8073
OR call 800-347-1011 (within the U.S. and Canada)
NOTE: For Doctors of Chiropractic in Canada: print out the WCA-Canada application(pdf format, requires Adobe Acrobat reader, available free from Adobe)