Washington State Chiropractic Association

Corporate Membership Application

Company Name
Primary Contact Name
Primary Contact Email
Title
Address
City
State
Zip
Phone
Fax
Company Website
Company Email

Secondary Contact Name
Secondary Contact Title
Secondary Contact Email

Check here if the contact information for your secondary company contact is different from above, and enter in the box below:

Description: In 50 words or less please describe your company's products and services:

Please select your category of membership:

Attorney
Billing and Collections
Chiropractic Service & Supply
Financial Services
Insurance Services
Nutritionals
Office Service & Support
Patient Education
Practice Management & Coaching
Radiologic Services
Other

Membership Information

Which level of membership are you applying for?

	Leadership	$5,000/year
	Platinum	$2,500/year
	Gold	$1,000/year
	Regular	$500/year

Past WSCA Member?
Yes No

If so, approximate year(s) of past membership?
to

Recommendation from Doctor of Chiropractic:

This active DC Member in good standing with WSCA can attest to the good moral character of your company and recommend its products and services in good faith to the chiropractic members of the Washington State Chiropractic Association.

Additional Questions/Comments?

Highlights of WSCA's Top
Corporate Membership Levels

$5,000/year

Enjoy these privileges exclusive to Leadership Level Members at BOTH the WSCA Winter AND Summer Conferences:
* Free premium booth space
*Sponsorship of one major event
*Opportunity to address the membership
*Registration desk recognition

Plus these extra privileges each year:
*FREE full-page ad or 2 half-page ads in one issue of Plexus Magazine each year (premium positions excluded)
*15% discount on all paid advertising
*Recognition in annual letter to entire membership
* Name and logo recognition as Leadership Level Member in all WSCA Publications
*Co-host one weekend seminar co-sponsored by WSCA with a guest speaker

$2,500/year

Enjoy these privileges exclusive to Platinum Level Membership at the WSCA Winter or Summer Conference of your Choice: *Free Premium booth space
*Sponsorship of one major event
*Opportunity to address the chiropractors
*Registration Desk Recognition

Plus these extra privileges each year:
*FREE half-page ad or 2 half-page ads in one issue of Plexus Magazine (premium positions excluded)
*10% discount on all paid advertising and conference registration fees
*FREE use of the WSCA offices for conferences and workshops
*Annual private reception with the WSCA officers and board of directors

$1,000/year

Enjoy these privileges of WSCA's Gold Level Membership:

*FREE 30-word classified ad in any four issues of Plexus each year
*Spotlight recognition in every issue of Plexus
*Featured Position in WSCA Marketplace, mailed to all Chiropractors in Washington State twice annually

These privileges are enjoyed by all of our top corporate members in the above listed Leadership, Platinum and Gold Levels:

*Recognition plaque for display at your office and at your display booths
*Identification on Contributors' Wall at WSCA Office
*Priority reservations for booth space at all annual conference
*Featured Position in WSCA Marketplace, mailed to all Chiropractors in Washington State twice annually
*Spotlight recognition in every issue of Plexus

WSCA - 21400 International Boulevard Suite 207 SeaTac, WA 98198

206-878-6055