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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.

 
Name:
Office Address:
City:
State/zip:
Phone:
Fax:
E-mail:
   -
Home Address:
City:
State/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?

     --
Enter any questions or comments you may have:


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