Illinois Prairie State Chiropractic Association

2025 FALL CONVENTION REGISTRATION FEES - BASIC MEMBER

Thank you for your registration...We look forward to seeing you there.

Meals are NOT included with your registration rate.

**BASIC REGISTRATION**
Chiropractor	$465.00
2nd DC - Same Office	$410.00
Chiropractic Assistant (CA)	$250.00
Retired Chiropractor With CE Credit	$250.00
Retired Chiropractor No CE Credit	$35.00
1st Year Chiropractor	$0.00
IPSCA Student	$0.00

**MEAL TICKETS**
Friday Evening Dinner	$65.00
Saturday Beacon Breakfast	$35.00
Saturday Luncheon	$35.00

Payment Information
Description	Member Registration-Fall Convention 2025
Payment Amount

Contact
First Name*
Last Name*
Email*
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Illinois License Number*
Chiropractic College
Additional Staff Registration
Additional Staff Registration
Additional Staff Registration
Additional Staff Registration
Number of Dinner Tickets
Number of Luncheon Tickets

Billing Address
Billing Address*
Billing City*
Billing State*
Billing Zip*
Billing Country*

Billing
Name On Card*
Credit Card Number*
Card Expiration Date*	/
Card Verification Code*	what's this?

First Name on Account*
Last Name on Account*
Bank Name*
Routing Number*	what's this?
Verify Routing Number*
Account Number*
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*Required

I affirm that the information entered on this form is true and correct and further declare that I have read, understand and accept Illinois Prairie State Chiropractic Association Terms as referenced in the [Terms of Use] link below.

Illinois Prairie State Chiropractic Association
PO Box 4174 Rock Island, IL 61204
(309) 797-9799

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