Memberships Forms

Message from the President         Member Benefits             Website Form

Membership Application

Name
Practice Name:
Address1:
Address2:
City:
State:
Zip:
County:
Phone:
Fax:
E-Mail:
Years in Practice:

 

Type of Practice:

Solo

Group

Associate

 

What Chiropractic groups do you belong to?

ICA                 ACA                 WCA                 FSCO

 

Chiropractic College:

Year Graduated:

 

Dues Category: Please check only one:	Annual	Quarterly
First 2 years in practice	$200	$50
Over 2 years in practice	$500	$125
Associate Doctor of member practice	$250	$62.50
Part Time Practitioner (16 Hours or Less)	$250	$62.50
Student, / C.A., / Retired D.C., / Out-of-state D.C	$25	n/a

 

Method of Payment:

Check for Annual dues Check for Quarterly dues Credit Card for Annual dues Credit Card for Quarterly dues Automatically Debit my Account Every 3 Mos.

	Please fill out form below if you wish to pay by credit card:
Name on Credit Card::
Card Number::
Type of Card::	Please select VISA MasterCard
Expiration Date:

 

Send check or money order to:

Chiropractic Fellowship of Pennsylvania

908 North Second Street

Harrisburg, PA  17102

 

Message from the President         Member Benefits             Website Form

For verification purposes, please type in the numbers and letters that you see below then press the Send Request button


Please click refresh if you came back to this page to fix some information to get the new verification image

E-mail the CFoP

 

Call (717) 441-6042 for payment through Visa or MasterCard

OR

Send check or money order to:

Chiropractic Fellowship of Pennsylvania

908 North Second Street

Harrisburg, PA  17102

 

Message from the President         Member Benefits             Website Form

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