Student Membership Renewal Form Student member application/renewal fee is $35 USD. If you are a NEW Student Member of BCTA/NA, please use the New Student Complimentary Membership Application for your first year of membership. Please note that membership payments are not eligible for refunds. Thank you. For a printable PDF, please click the button below: Student Membership Renewal Form To renew online, please fill out the form 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) Best phone number for you, so we can contact you if needed Phone Number Foundation Training Information Please List all Foundation Teachers (required) Training Completion Date (day/month/year format please) (required) All Applicants I authorize the BCTA/NA to provide all communication for official organizational business to me via email, including the monthly E Newsletter and yearly Cranial Wave Publication PDF (I authorize paperless communication). YesNo Comments Payment Options Please let us know how you prefer to make your payment. I will make a secure online payment using credit/debit card or eCheck (from a personal account at a U.S. bank)I will be paying via check by mail If you are paying by 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 11006 Connally Lane Raleigh, NC 27614 239-206-6078 Send Email 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.