ChiroCongress Member State Association Updates

In order for your association leaders to stay in touch with all that is happening we need to update our records on a regular basis.

Name of Organization

No abbreviations please.
What date are these changes effective? What date are these changes effective? / MM / DD YYYY
Primary Contact Name Primary Contact Name First Last
This is who will be designated as the primary contact for your association in our database.
Primary Contact Title

Executive Director, CEO or association President
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Company Email (or generic email if available)

Please list the generic email address that your association uses to receive public emails.
Web Site
Year your association was incorporated or chartered
How many licensed DCs are members of your association?
How many licensed DCs in your state?
When will your next association leadership elections be held? When will your next association leadership elections be held? / MM / DD YYYY
Executive Leadership & Staff
Executive Director Executive Director First Last
Executive Director Email
Support Staff Name Support Staff Name First Last
Support Staff Title
Support Staff Email
I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.)

I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.) Yes No
Board Members

Please provide your current board members. This will enable us to add them to the database to register for events and will tell us whether they should receive communications from ChiroCongress directly.
President Name President Name First Last
President Email
I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.)

I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.) Yes No
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Vice President Name Vice President Name First Last
Vice President Email
I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.)

I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.) Yes No
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President-Elect Name President-Elect Name First Last
President-Elect Email
I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.)

I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.) Yes No
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Past President
Past President Email
I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.)

I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.) Yes No
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Secretary Name Secretary Name First Last
Secretary Email
I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.)

I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.) Yes No
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Treasurer Name Treasurer Name First Last
Treasurer Email
I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.)

I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.) Yes No
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Medicare CAC Rep Medicare CAC Rep First Last
Medicare CAC Rep Email
I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.)

I would like them to receive communications from ChiroCongress (listserv posts, monthly newsletter, announcements, etc.) Yes No
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If you have any staff or association leaders beyond the people you've listed above that you want added or removed, please provide their name, title, and email here.

ChiroCongress Member State Association Updates

ChiroCongress Member State Association Updates

Executive Leadership & Staff

Board Members

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