New Mexico Chiropractic Association

MEMBERSHIP APPLICATION

To download printable membership application form,
click here for a printable Word document
or click here for a printable PDF.

MEMBERSHIP DUES CAN NOW BE PAID BY AUTOMATIC DEDUCTION

Click Here for an EZ-Pay Form. Check membership application for the amount of dues applicable to you.

Please fax (505-828-1128) or mail (NMCA, P. O. Box 21100, Albuquerue, NM 87154) this form to the association.

POLITICAL ACTION COMMITTEE CONTRIBUTIONS CAN NOW BE PAID BY AUTOMATIC DEDUCTION

Click Here for an EZ-Pay Form for contributions.

Please fax (505-828-1128) or mail (NMCA, P. O. Box 21100, Albuquerque, NM 87154) this form to the association.

Our forms are in PDF(Portable Document Files)format. To read these you need to have Acrobat Reader installed on your computer. You can download it free. Click here to download Adobe Acrobat Reader.

2008 MEMBERSHIP DUES
Membership	(All dues are calendar year.)	TOTAL:
Regular Member:	$500 annually, to be paid _____ monthly _____annually	$_____
Regular Member:	$250 annually for Doctors working part time due to impairment or illness, confirmed by physician _____ monthly _____annually $250 annually for previously licensed DC NEW to NM ____monthly _____annually	$_____ $_____
New Licensee:	$0.00 annually (within 1st 12 months), $100 annually (within 2nd 12 months), & $200 annually (within 3rd 12 months)	$_____
Out-of-State Doctor:	$150 annually (licensed DC practicing outside NM)	$_____
Student:	$25 annually	$_____
Professional Associates:	$100 annually (non-DC business or individual) $_____	$_____
Honorary Member:	Exempt from dues (retired and age 60+ or disabled)	$_____
Early Renewal:	If paying by December 31, deduct 10%	$_____
CONTRIBUTIONS:
PAC:	Non-deductible political campaign contribution fund	$_____
President's Circle:	Non-deductible legislative expense & lobbyist fund Member: $1,000 or more; Associate: $1-$999	$_____
Scholarship Fund:	Contribute to helping new Doctors of Chiropractic	$_____
PR Media Fund:	Making Chiropractic visible throughout NM	$_____

To download printable membership application form, click here for a printable Word document or click here for a printable PDF.
I am applying as a _________________________ member. Enclosed is		$_____
I am paying by Visa # _____________________________Expiration Date: ______
I am paying by MC# ______________________________ Expiration Date: ______

I am paying by Discover #_________________________ Expiration Date: ______
*PLEASE REFER A COLLEAGUE:_________________________________________*

PLEASE MAKE OUT SEPARATE CHECKS FOR MEMBERSHIP, PAC AND PRESIDENT'S CIRCLE. Please mail application with credit card information, check or money order to: NMCA, P. O. Box 21100, Albuquerque, NM 87154