w s c a | Para-Professional Membership Application

Join WSCA!

Washington State Chiropractic Association
Para-Professional Membership Application
21400 International Blvd. Ste. 207 | SeaTac, WA 98198
[ph] 206.878.6055 [fax] 206.878.8699

NEW MEMBER RETURNING MEMBER

CONTACT INFORMATION

*required

Name	*
Clinic Name
Address	*
Suite/Apt
City	*
State	*
Zip	*
Phone	*
Fax
Email
Web Site

SKILLS & EXPERIENCE

Indicate all that apply:

Office Manager		Years Experience
X-Ray Technician		Years Experience
Chiropractic Assistant		Years Experience
Receptionist		Years Experience
Other (please specify below)		Years Experience
		Years Experience

Please list relevant degrees, certifications, or training programs:

Additional questions or comments?

Para-Professional membership is $75 per calendar year.

My check is in the mail

I will contact WSCA to make payment arrangements

your application electronically

OR

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