Sign-up Here To maximize our effectiveness for you, please choose which option closest describes your practice and/or your vision for your future… (Choose One) My practice is primarily relief and referral based. I get patients better then let them, go. Many come back and refer others. My practice is primarily corrective and maintenance/wellness focused. Your First and Last Name: Practice Name: Practice Address: Do Not Use Your Home Address City: State: Zip Code: Practice Phone: Do Not Use Your Cell or Home Phone Number Practice Fax: Practice Website: Your E-mail Address: Valid e-mail is required T-shirt Size: Choose One SMALL MEDIUM LARGE X-LARGE XX-LARGE Credit Card: Choose a Card American Express Discover Master Card Visa Credit Card Number: No dashes or spaces please Expiration: MMYY Verification: 3 digits on back, or 4 on front for AMEX This is a month-to-month membership. No long-term contracts or commitments. $397 per month.
