Licensed DN Membership Application

You Must Hold a DN License in IL, NM, NV or OH for this Application.

**MEMBERSHIP DUES AND ALL CONTRIBUTIONS TO ANA ARE TAX-DEDUCTIBLE **

Message from ANA President Griggs

You are a part of the future of this great profession. Without your participation and dues support, the association could not fulfill its commitment to helping every Naprapath in this country practice with their full rights and privileges. Your membership means that the American Naprapathic Association can continue to be an active and vital part of the health care community and potentially break down barriers that Naprapaths have faced in the past. Each passing year we focus on improving the following: • Increased membership and membership retention, • More opportunities for licensed and practicing Naprapaths in mainstream medicine • Sufficient compensation / reimbursement with insurance carriers • Increased student enrollment with in the profession • Closely knitted relationships with the Illinois & New Mexico Naprapathic Association(s) • Gaining political support for this upcoming sunset with the Illinois Department of Financial & Professional Regulation (IFDPR). Your participation and dues support make these and other valuable opportunities possible. Every member strengthens the association’s political clout in unison with each state’s chapter i.e. (INA for IL Licensed Naprapaths). Even when you don't have the time to be personally involved, your membership dues support the actions of other association members who work for better government. As a member, you make everything we do possible. Please renew your membership by June 1st. This will give you ample time to avoid late fees and so that you can continue to receive mailings without interruption. If this date has passed already, please be sure to renew as soon as possible to take advantage of our membership incentives throughout the year. Your involvement is important and very much appreciated. Sincerely, ANA Board of Directors “Committed to serving Naprapathic Doctors”

Applicant Information

***Used for Statistic and Demographic Information only***
***Used for Statistic and Demographic Information only***
***Used for Statistic and Demographic Information only***
***Used for Statistic and Demographic Information only***
***Used for Statistic and Demographic Information only***
***Used for Statistic and Demographic Information only***
***We will not share or disclose this information (for ANA internal use only)***
***We will not share or disclose this information (for ANA internal use only)***
***We will not share or disclose this information (for ANA internal use only)***
***We will not share or disclose this information (for ANA internal use only)***
Important to complete for practitioners with private offices and businesses. ***We will only share office information with your consent***
As an incentive to membership, your office / practice information will be displayed on the ANA Official Website under "Find A Naprapath".
Please provide the link for your "Linked In" profile below ***leave blank if not applicable***
Please provide the link for your "Linked In" profile below ***leave blank if not applicable***
Please provide the link for your website ***leave blank if not applicable***

Educational Information

The American Naprapathic Association does not discriminate on the basis of race, religion, creed, sex, age, marital status, disability, national origin or sexual orientation in its educational programs, activities or employment practices. List all secondary and post-secondary institutions attended, in chronological order, beginning with the most recent attended.
Click or drag files to this area to upload. You can upload up to 4 files.
Please upload any and all degrees, diplomas and / or certificates.

DN Licensing Information

Click or drag files to this area to upload. You can upload up to 2 files.
Application is considered incomplete with failure to upload other medical or professional license. You may save your application and resume later once all documents are available to upload.

Additional Licensing Information

If no is selected, you may license information area blank.
Click or drag files to this area to upload. You can upload up to 4 files.
Application is considered incomplete with failure to upload other medical or professional license. You may save your application and resume later once all documents are available to upload.
Click or drag files to this area to upload. You can upload up to 2 files.
If more than once license has been disciplined, please upload separate explanations for each. Application is considered incomplete with failure to upload required documents. You may save your application and resume later once all documents are available to upload.
Please tell us any other volunteering commitments that you may have. ***Completion of ANA Conflict of Interest Disclosure Form will be required in ANA Board Members application process.***

Thank You for completing the ANA Membership Application.

Please be sure to date and submit your form.
Price: $ 150.00
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