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Membership Application

To submit an application for membership, either

  1. By mail-download this form, provide the requested information, and mail along with your $25 application fee to: CAL, 10636 Timberlake Ave, Baton Rouge, LA 70810
  2. Electronically-provide the requested information and click "submit." 
    You will receive a statement for the $25 application fee.

Your Name


* Name:



Office Address


Street Address:
City:
State:
Zip:
* Email:
Phone:
Fax:




Home Address


Home Address:
Home City:
Home State:
Home Zip:
Home Phone:




Education


Chiropractic College:
Year of Graduation:
Degrees Earned:
Other Degrees Held:




General Information


Birthdate:
Spouse's Name:
How did you learn about CAL?
Additional Questions:
Enter Verification Characters:

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* required information