If you would like to apply for membership in the National Association For Chiropractic Medicine: 1) Print this application from your Web browser 2) Fill out the application in its entirity and 3) Mail this application to the address listed at the bottom of the application.

URL: http://www.chiromed.org / e-mail: r_slaughter@msn.com

MEMBERSHIP APPLICATION/BY INVITATION ONLY

___________________________________________________________

Sponsoring Member Signature _____________________Date _______

NAME: ____________________________________________________

(AS WILL APPEAR ON MEMBERSHIP CERTIFICATE)

ADDRESS: _________________________________________________

OFICE PHONE: _________________FAX: _______________________

HOME PHONE: ________________e-mail: ______________________

STATE(S) LICENSED: _______________________________________

ATTACH CURRICULUM VITAE & THIS YEAR'S TELEPHONE AD

I AGREE:

• TO ABIDE BY THE GUIDELINES OF PRACTICE OF THE NACM
• VIOLATION OF ANY GUIDELINE OF PRACTICE ADOPTED BY VOTING MEMBERSHIP OF THE NACM WILL RESULT IN IMMEDIATE CANCELLATION OF MY MEMBERSHIP BY MEMBERSHIP COMMITTEE VOTE AFTER APPROPRIATE INVESTIGATION AND WITH NO APPEAL.
• FALSIFICATION OF INFORMATION SUPPLIED FOR MEMBERSHIP WILL RESULT IN IMMEDIATE CANCELLATION OF MEMBERSHIP

I SWEAR MY LICENSE TO PRACTICE IS VALID, IN GOOD STANDING, AND NO CURRENT INVESTIGATION IS ONGOING PURSUANT TO SUSPENSION OR REVOCATION OF MY LICENSE TO PRACTICE

SIGNATURE:___________________________DATE:_______________

MEMBERSHIP FEES: Licensed, practicing chiropractor-------$100.00 annual fee

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A QUARTERLY NEWSLETTER WILL MAKE NOTIFICATION OF ALL CONFERENCES AND CONTINUING EDUCATION. THIS OFFICE OR YOUR STATE ORGANIZATION WILL NOTIFY YOU EITHER FOR NEWS UPDATES AND MEETINGS.

The National Association for Chiropractic Medicine (NACM) scope of membership practice is defined to encompass the study and treatment of the biomechanics of the spine with emphasis placed on locomotion and on the manipulation of a specific joint dysfunctional disorder. The objective is governed by the applied life sciences and in accordance with the accumulated knowledge of those life sciences. Specific diagnostic and procedure protocols are determined as a product of on-going post-graduate education and by published, peer reviewed literature. As a member, I acknowledge the guidelines set forth by the Association and understand that in the event that I fail to comply with these standards NACM membership committee will revoke my membership following an investigation.

"DEDICATED TO BRINGING PROFESSIONAL MANIPULATIVE PROCEDURES INTO MAINSTREAM HEALTHCARE DELIVERY"

ALLOW SIX WEEKS FOR ACTION ON APPLICATION

MAIL TO: 15427 Baybrook Drive, Houston, TX 77062

If you have questions about NACM or you would like for us to contact you, please e-mail us at: ronlslaughter@hotmail.com