Allied Application or Renewal Form

BCTA/NA Allied Application/Renewal Form

Allied application/renewal fee is $50 USD.

Please note that membership payments are not eligible for refunds. Thank you.

If you are applying as a new Allied member after January 1st of the current renewal period, your new membership fees will include the next year’s renewal period.

For a printable PDF, please click the button below:

Allied Application or Renewal Form

To apply or renew online, please enter your information below:

Contact information

(for use by the organization)

First Name (required)

Last Name (required)

Your Email (required)

Address (required)

Address 2

City (required)

State/Province (required)

Country (required)

Zip/Postal Code (required)

Your best phone number, so we can contact you if needed.

Phone Number

Are you a new or renewing Allied member?

All Applicants

I authorize BCTA/NA to provide all communication for official organizational business to me via email, including the monthly E Newsletter and yearly Cranial Wave Publication (I authorize paperless communication).

Comments

Payment Options

Please let us know how you prefer to make your payment.

If you are paying with online credit/debit card or eCheck, you will be immediately sent an email with the payment link attached.

If you are paying via check by mail (U.S. banks only please), please send to:

BCTA/NA
115 Williamston Ridge Drive
Youngsville, NC 275969
239-206-6078
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By submitting this form, you are agreeing that the information provided is accurate and that BCTA/NA can process your request as if your signature has been provided.