Become a member Members are the life-blood of our organization. If you're not already a member - please consider signing up today. You can select the membership level the fits your budget and needs below. Membership Levels Please select the appropriate membership level below. You will have a chance to review your selection and the corresponding dues on the next page prior to your credit card being charged. If you have a discount code, enter it here Apply Membership * Practitioner - $ 295.00 Allied Health - $ 150.00 Pharmacy/Corporate - $ 500.00 Please renew my membership automatically. Membership will renew automatically. Total Amount Please enter a Username to create an account. If you already have an account please login before completing this form. Username * Check Availability Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores. New Member Profile First Name * Last Name * Credentials MD ND DO NP DC RN RPh LAc M.D.,MBA, FAARFM,ABIHM Family Nurse Practitioner DC, MS MD, MPH Lobbyist MS,RD MHS, PA-C MD, FACOG, NCMP DACM, LAc PhD, CHC, AIPCC, GMC FNP-C PharmD, CDCES III Opila-Lehman D.C., D.A.B.C.I., D.A.C.B.N. MD, ABIHM, MBA PharmD RN BSN 2 FNP MSN NP-C PA-C IBCLC APRN-C DMD, MNu, MPH DC CTN CAcu, HeartMath ND, MS PA Professional Category Email Address * Credit Card Card Type - select - Visa MasterCard Amex Discover Card Number * Security Code * Expiration Date * -month- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -year- 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Billing Name and Address Billing First Name * Billing Middle Name Billing Last Name * Street Address * City * Country * - select - United States State/Province * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * Review your contribution
