Illinois Prairie State Chiropractic Association

Membership Application

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Terms: I authorize Illinois Prairie State Chiropractic Association to debit the account listed hereon $25.00, & agree to perform the issuer obligations. I affirm that the name and personal information provided on this form are true and correct and further declare that I have read, understand and accept Illinois Prairie State Chiropractic Association Terms as referenced in the [Terms of Use] link below.

By clicking on [Submit] I hereby apply for membership in the Illinois Prarie State Chiropractic Association, Inc., and am submitting an application fee of $25.00. I understand that my application is subject to membership approval and that I will be notified of its action. I hereby pledge my support to help preserve and advance chiropractic in the State of Illinois and agree to abide by the Constitution, By-Laws, and Standards of the IPSCA.

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Illinois Prairie State Chiropractic Association
PO Box 4174 Rock Island, IL 61204
(309) 732-3233

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