Missouri State Chiropractors Association

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MSCA Partners

Financial Advisory Services & Disability for Chiropractors

Credit Card Processing.

Comprehensive Coding and Reimbursement Resource.

Chiropractic Software Documentation, Patient Tracking, and Office Management.

Cutting Edge Risk Management
Free Red Flags Training

Discount for MSCA Members

Payment Processing & Check Recovery Company.

Professional Debt Collection Services

Free patient referral for MSCA members (plus optional upgrade)

TPK Backsaver Wallets Eliminate Sciatica due to sitting on a wallet.

MSCA 2010 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, 2010.

	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 2010 MSCA dues has been calculated to be 82%. The non-deductible percentage is 18% and relates to our lobbying activities.

Please bill $ ________to my

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.

Missouri State Chiropractors Association
220 E. Dunklin
Jefferson City, MO 65101
Phone: 573-636-2553 - Fax: 573-635-1470