To better meet your needs, we would appreciate your answers to the following selections: BOARD CERTIFICATIONS ____Radiology _____Neurology ____Family Practice/Internal Medicine _____Nutrition ____Orthopedics _____Behavioral Health ____Occupational Health _____Physiological Therapeutics Sports Medicine ____________ Radiology
PRACTICE ____Private Practice _____Oriental Medicine ____Outpatient Clinic _____Acupuncture ____Faculty / Teaching _____Clinic Multi-Disciplinary ____Occupational/Rehabilitative _____Group Practice ____Preventive Medicine / Wellness _____Other
CFP (New Member First Year $150 USD) ________
Renewal - $120 (USD) _________
Student Member- $40 (USD)_______
Corporate Member - $500 (USD) _______
Collect Member - $500 (USD) ________
Associate Member (non-DC) $90 (USD) ________
Please accept my additional contribution of $ _________ to further the work of the Council
By completing and signing this application for membership, the applicant supports and fosters the tenets and purposes of CDID. Lack of support and fostering of the tenets and purposes of CDID will lead to denial or revocation of membership.
Each dues paying member receives an annual subscription to the Journal of Chiropractic Internist as part of their dues at no extra charge.
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Three digit code on the back of your card____________.