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FICS Appplication form

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I hereby apply for membership of the:

Institution/Organisation
 
Title of Contact person
First Name, LASTNAME
Function
Street
Zipcode
City
Country
Phone
Fax
e-mail
Internet Address

Please check the correct category:

   

annual membership fee


 

 Ordinary members

National Chiropractic Sports Councils (independant from their National Chiropractors Association)

Each individual members of this NCSC x 20 US$

200 US$


 

 

 Associate members

National Chiropractors Association, Chiropractic Schools, other Institutions, ...
Independant Chiropractors, other individuals, ...

200 US$

 

40 US$

Payment:

by cheque   
When paying by cheque, please add the following amounts to cover bank fees:
+$ 10.00  
   
by bank transfer   
Bank Account UBS S.A. Lausane (Switzerland)
  Account # F9-362,346.0

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