New Graduate Membership – Chiropractors Nova Scotia

Name:

First Name Required Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

NSCC License Number: NSCC License Number is not valid

Clinic Name: Clinic Name is not valid

Clinic Street: Clinic Street is not valid

Clinic City: Clinic City is not valid

Clinic Phone: Clinic Phone is not valid

Clinic Province: Clinic Province is not valid

Clinic Email Address: Clinic Email Address is not valid

Clinic Name 2 : Clinic Name 2 is not valid

Clinic Street 2: Clinic Street 2 is not valid

Clinic City 2: Clinic City 2 is not valid

Clinic Phone 2: Clinic Phone 2 is not valid

Clinic Province 2 : Clinic Province 2 is not valid

Clinic Email Address 2: Clinic Email Address 2 is not valid

Clinic Name 3: Clinic Name 3 is not valid

Clinic Street 3: Clinic Street 3 is not valid

Clinic City 3: Clinic City 3 is not valid

Clinic Phone 3: Clinic Phone 3 is not valid

Clinic Province 3: Clinic Province 3 is not valid

Clinic Email Address 3: Clinic Email Address 3 is not valid

I agree that a membership subscription fee of $1.00 will be automatically charged to my credit card on a recurring monthly basis during the first 12 months of my NS Chiropractic License (based on the initial date of licensing). In the event the automatic payment is declined, I understand that my membership with CNS will be paused until payment is brought up to date. Failure to bring missed payments up to date within 30 days will result in membership cancellation :* I agree that a membership subscription fee of $1.00 will be automatically charged to my credit card on a recurring monthly basis during the first 12 months of my NS Chiropractic License (based on the initial date of licensing). In the event the automatic payment is declined, I understand that my membership with CNS will be paused until payment is brought up to date. Failure to bring missed payments up to date within 30 days will result in membership cancellation is Required

yes

I acknowledge that upon the anniversary date of my chiropractic license, I agree that my monthly membership fee will increase to match the current full CNS membership rate. CNS reserves the right to further increase or decrease membership fees with a minimal of 30 days prior notice to be provided :* I acknowledge that upon the anniversary date of my chiropractic license, I agree that my monthly membership fee will increase to match the current full CNS membership rate. CNS reserves the right to further increase or decrease membership fees with a minimal of 30 days prior notice to be provided is Required

yes

I acknowledge that my CNS membership is dependant on verification of current Chiropractic License with the Regulator:* I acknowledge that my CNS membership is dependant on verification of current Chiropractic License with the Regulator is Required

yes

Would you be interested in receiving future text notifications on important CNS announcements or events?: Would you be interested in receiving future text notifications on important CNS announcements or events? is not valid

yes no

Cell Phone : Cell Phone is not valid

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

CNS

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Pay Chiropractors Nova Scotia

1 Year for $1 then $99 / Month

Terms: 1 Year for $1 then $99 / Month

	New Graduate Membership – Initial Payment 1 Year for $1 then $99 / Month	$1.00
	Total	$1.00

New Graduate Membership – Initial Payment

1 Year for $1 then $99 / Month

$1.00

Total

$1.00