International Spine Association

Public Membership

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