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American Chiropractic Association
Council on Diagnosis and Internal Disorders
Symposium 2008 Registration
Please print this form and send the completed copy
to the address below.
Register Toll Free:
Voice: 888-393-0336
Register By Fax:
704-845-8589
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Mail Registration:
Dr. Philip Arnone
Attn: Stacey
PO BOX 2150
Matthews, NC 28106
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* Membership dues to the American Academy of Chiropractic
Physicians or the Council on Diagnosis and
Internal Disorders-ACA includes
free annual subscription to Holistic Primary Care and The Original Internist and free
membership updates.
Symposium 2008 Cancellations after June 30,
2008 are subject to a 50% cancellation fee.
(Please Print)
Name: ___________________________________________________________________________
Address: _________________________________________________________________________
City: ___________________________ State: ______________
Zip: _________
Phone: (_____) ___________ E-Mail:
_____________________________________________
Method of Payment: Check
Visa MasterCard
Credit Card Number: _________________________________________
Expires: _________________
Signature: _______________________________
Amount Enclosed (charge amount): $_____________
All credit cards charges will display as 'The Balanced Body Center' on your statement.
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