Online Application / Renewal

If you prefer, download the membership application (PDF)

Personal Information


College Information

Students provide anticipated date of graduation

Other Credentials
Chiropractic License

Application Fee


Please note when you click the 'Step 2 - Payment' button your 'registration' will be sent to our office and you will be connected to our secure payment processing system. If you have any questions or problems, please call us at 703-528-5000 or 800-423-4690 to process your payment. Thank You.

Your Total: $