OSCA Member Application

Contact Information

First Name
Last Name
Title
Email
Cell
College Attended
Referred by
License Number
Birthday ?

Company/Clinic Information

Company/Clinic Name
Mailing Address
 
City State Zip
County
Phone Fax
Website

Membership Categories

Standard Membership (Most Popular!) $750
Access to Online Resource Center. Access to OSCA staff for Q&A. Free access to OSCA’s CE webinars ($600+ value). Access to OSCA affiliate discounts ($400+ value).
Standard Membership Associate $400
Doctor who practices under a member DC, who has a current Standard Membership status.
Membership Plus $1500
All elements of Standard Membership, plus: ALL OSCA-run CE seminars are FREE, including conventions. 2 Free staff convention registrations. VIP receptions & exclusive invitations & opportunities. Enhanced legal benefits & access.
Membership Plus Associate $1100
Doctor who practices under a member DC.
Joint Membership $950
For husband and wife only, with the provision that one of the members does not conduct a full-time practice.
Standard Membeship Status
Joint Membership Plus $1890
For husband and wife only, with the provision that one of the members does not conduct a full-time practice.
Membership Plus Status
First Year Licensed $300
Standard Membership Status
Semi-Retired/Pert-Time $550
Less than 20 hrs/wk
Standard Membership Status
Retired $150
Standard Membership Status
Out-of-State $100
Standard Membership Status, no voting rights.
Student $20
Standard Membership Status, no voting rights.

Membership Information

Please Choose your Membership Category:
 
Primary Member or Spouse (if applicable to your membership category)
 
Payment Plan
 Annual - Pay entire amount now (can be prorated)
 Quarterly - Charge 4 payments* (March, June, Sep, & Dec)
Please select an option:
Future Payments
Please select an option:

* NOTE: Quarterly and/or Invoice options will be assessed a $20 administrative fee per quarter.

I hereby certify that my Ohio chiropractic license is current, active and without disciplinary action; I am not in default of any dues owed to the OSCA; I am not in violation of any of the provisions of the OSCA By-Laws, Articles of Incorporation, Code of Ethics and/or policies; and I have never pleaded guilty, entered a plea of nolo contendere, or been found guilty by a judge or jury of a felony.
Please Certify

Optional Support:

Ohio Chiropractic Foundation (OCF)

I want to support the OCF’s mission of chiropractic education and outreach. Add an additional payment to my dues in the amount of:
$per dues transaction.
   - denotes required fields