THANK YOU for your membership into the Illinois Prairie State Chiropractic Association (IPSCA).  Your application will be processed and notification will be sent to you.

   IPSCA MEMBERSHIP LEVELS:

Full Membership

  • Basic Membership: 
  • Annual Basic Dues -  $500  
  • Reocurring Monthly Basic Dues - $50
  • Beacon Membership: 
  • Annual Beacon Dues - $1,000  
  • Reocurring Monthly Beacon Dues - $100

2nd or 3rd Year Chiropractors

  • Basic 2nd or 3rd Year Chiropractor:
  • Annual Dues - $250 
  • Reocurring Monthly Dues - $22
  • Beacon 2nd or 3rd Year Chiropractor:
  • Annual Dues - $500
  • Reocurring Monthly 2nd/3rd Year Dues - $50

1st Year Chiropractors and Students please contact the IPSCA regarding membership discounts - Phone: 309-797-9799 or Email: jreyes@illinoischiropractors.org

Payment Information
Description Application
Payment Amount
Frequency
When will monthly payments start?
How long will payments go?
How many monthly payments?
Contact
First Name*
Last Name*
Email*
Office Address, City,
State, Zip*
Office Telephone*
Illinois License Number*
Year IL License Obtained*
Chiropractic College*
Graduation Year*
Other Professional
Organizations
Scientific Instruments
Used*
Techniques in Practice*
Reason For Joining*
Membership Type*
Billing Type (Yearly,
Monthly)*
Optional Lobbyist
Donation Amount
Optional PAC Donation
Amount
Website
Billing Address
Billing Address*
Billing City*
Billing State*
Billing Zip*
Billing Country*
Billing
Name On Card*
Credit Card Number*
Card Expiration Date*  / 
Card Verification Code* what's this?
First Name on Account*
Last Name on Account*
Bank Name*
Routing Number* what's this?
Verify Routing Number*
Account Number*
Verify Account Number*
Check To Confirm
Enter /Your Full Name/
to Sign and Authorize.
*Required



Terms of Use | Privacy Policy
Illinois Prairie State Chiropractic Association
PO Box 4174 Rock Island, IL 61204
(309) 797-9799
Powered by Cash Practice® Systems