Oklahoma Chiropractors' Association

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Application

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Application Information

Name^*

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Female

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Clinic Information

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Education Information

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OK License # (if student, write NA)^*

Licensed in other States^*: Yes
No

Membership & Dues

Membership Category^*: Premium Member $1200/yr
Regular Member $600/yr
New Doctor Member $100/yr (1st and 2nd year in practice)
Senior Member No Charge
Student Member $25/yr

Payment Option^*: Annually (automic withdraw)
Quarterly (automatic withdraw)
No Charge (Senior Membership)

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