Online Membership ApplicationStart the application process below. You will be able to pay online during the next step.Name* First Last Company/Organization NameTitleEmail* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Membership Type*Student ($25)Individual ($30)Business Sales ($50)Professional ($100)Corporate-Supporter ($500)Select your skills and fields of interest:* Acupuncture, Oriental Medicine Activism Ayurveda Business Chiropractic Clergy Energy Healing Government Homeopathy Legal Massage Medicine Naturopathy/Natural Medicine Nursing Reiki Spiritual Healing Other (specify below)Additional CommentsProceed to next page for payment using Credit Card or Paypal.CommentsThis field is for validation purposes and should be left unchanged.
