Public Membership


International Spine Association

Purpose

You have been diagnosed with a chronic spine condition. Your attending physician has recommended that you become a member of the International Spine Association (ISA) to remain informed about your condition and available self-care and treatment options. The ISA is an international organization dedicated to educating the public and healthcare professionals about the spine, spine disorders and available spinecare.

The annual membership fee is 20.00. This represents a commitment of less than 1.67 per month in your healthcare.

Benefits of Membership Include:

  • Spinecare eBook

  • Online access to “need-to-know” information 24/7

  • Periodic eNewsletter

  • Discounts on backcare related products

  • Unique user login ID

  • Access to spinecare updates

  • 30 Tips to spine health

  • Locate a spine specialist feature

Public Membership Application
Personal Information
First Name Last Name
Address City
State Zip
Providence Country
Email Phone

Credit Card Information
CC Number CC Type
Security Code CC Expiration /
CC Address CC City
CCState CC Country

Terms
Membership is for one year from the time of acceptance. To prevent a lapse in coverage membership will automatically renew on the membership anniversary date unless you notify the ISA in writing in advance.

To receive full membership benefits you must provide a current email address. Please inform the ISA if your contact information changes. Your signature below authorizes the ISA to charge your account at the time of initial membership acceptance and at the time of membership renewal. If you paid by check a bill will be sent to you when it is time for renewal


Signature Date




INTERNATIONAL SPINE ASSOCIATION
1795 GRANDSTAND PLACE, ELGIN ILLINOIS 60123
(847) XXX-XXXX
www.spinehealth.info
Copyright © 2007 International Spine Association
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