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MSCA 2008 Membership Application
Click here to download this application as a PDF file
(If You’re Already A Member, Ask Another DC To Join!| Name | |
| Practice or Company Name | |
| Office Address | |
| City/State/Zip | |
| Office Phone | |
| Fax Number | |
| Office County | |
| Home Address | |
| City/State/Zip | |
| Home Phone | |
| E-mail Address | |
| Date of Birth | |
| Chiropractic College | |
| Graduation Date | |
| If student, Expected Graduation Date | |
| Date & State of First Licensure | |
| Missouri License No. |
Select MSCA Membership Level
The MSCA membership year is January 1 through December 31, 20087.
| Monthly | Quarterly | Annually | |
| Regular Member | $33.33 | $100.00 | $400.00 |
| Fourth-Year DC | 25.00 | 75.00 | 300.00 |
| Third-Year DC | 16.66 | 50.00 | 200.00 |
| Second-Year DC | 8.33 | 25.00 | 100.00 |
| First-Year DC | FREE | FREE | FREE |
| 65 or Older | 16.66 | 50.00 | 200.00 |
| Faculty | 16.66 | 50.00 | 200.00 |
| Out-of-state | 8.33 | 25.00 | 100.00 |
| Associate (non-DC) | 16.66 | 50.00 | 200.00 |
| Student | ($25 one-time charge or $10 annually) | 10.00 | |
I choose not to be a full member at this time, but would like to help the MSCA in it’s fight to defend, preserve and advance chiropractic for all chiropractors in the state of Missouri by contributing as a donor.
Donor ($10-199)
The tax deductible portion of your 2008 MSCA dues has been calculated to be 70%. The non-deductible percentage is 30% and relates to our lobbying activities.
Billing Type
Method of Payment: Convenient payment plans are available. Dues can be automatically charged to your credit card semi-annually or quarterly, or they can be debited from your checking account automatically every month.
*Important: For your convenience, automatic monthly debits and quarterly charges continue annually. You may call to cancel at any time.
**Checking Auto Debit: To start automatic debit from your checking, please call the MSCA office and a debit form will be sent to you.
Make checks payable to MSCA.
| Credit Card Number | |
| Expiration Date | |
| Signature | |
| Date |
Make checks payable to MSCA and mail to:
MSCA, 220 E. Dunklin, Jefferson City, MO 65101. Phone: 573-636-2553. Fax: 573-635-1470.
MCSA Partners:
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