Membership Application

MAC Mission

To improve the health and well being of the public by advancing and protecting the practice of chiropractic.

Purpose of the MAC

The purpose of the Michigan Association of Chiropractors is:

To promote the Chiropractic profession as a distinct branch of the healing arts based on the body’s inherent recuperative abilities and the role that vertebral subluxation plays in that process, and
To advocate for Michigan Doctors of Chiropractic, chiropractic patients, and the chiropractic profession to the government, the public, the business community, and the community of third party payers.

This application must be filled out in its entirety for approval of the Board of Directors.

Please fill out the online form below, or click here for a .pdf form, which you may fax back to the MAC at (517) 367-2228.

Michigan Association of Chiropractors
Membership Application

Date:
	Please Check One: New Member Upgrade Membership
Name
Birthdate
Male Female
Office Name
Office Address
City State Zip Code County

Home Address
City State Zip Code

Phone Numbers: Office
Home Fax
Email Address Web Site
Techniques practiced
Chiropractic College
Graduation Date Date of First Licensure
Date Licensed in Michigan License Number

Membership Type and Fees Please select one. Quarterly payment schedule available.
	Student	FREE
	First year (of Michigan licensure)	FREE
	Second year (of Michigan licensure)	$ 360.00
	Third year (of Michigan licensure)	$ 480.00
	Fourth year+ (of Michigan licensure)	$ 720.00
	Semi-Retired	$ 200.00
	Century Club**	$1,200.00
	Ambassadors Club**	$2,220.00
	Presidents Club**	$3,420.00
	Retired	$ 50.00
	Associate member (MAC Board approval/15 hrs or less/week	600.00
	Spouse member (1/2 pf primary member dues, not to exceed $600)	TBD
	Vendor member	$ 300.00
	** Includes two (2) free conventions per year for the Century, Ambassadors or Presidents Club Member DC, discounts on seminars, and more.

By filling out this form, I hereby attest to the accuracy of the foregoing information. I agree to abide by the By-laws, Code of Ethics and Chiropractic Statutes of Michigan. I understand that my failure to remit dues will result in suspension of all rights and privileges and will result in the loss of membership. Dues are paid in advance.
Dues Payment Options:
I will mail a check for my membership dues to the MAC (address at the top of this page)
Please set up my account for automatic credit card billing (VISA, Discover, or MasterCard) Please call the MAC office at (800)949-1401 to provide your Credit Card number.
Please bill me for my membership dues

*Please send or e-mail a photograph immediately after filling out the application form.*

Michigan Association of Chiropractors
416 W. Ionia, Lansing, Michigan 48933 ● www.chiromi.com
(517) 367-2225 ● (800) 949-1401 ● Fax (517) 367-2228 ● Contact us

Sue Quinn Palin, Webmaster

First published - January 3, 2007 Last updated July 31, 2008 12:17:53 PM