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).

Comments

Payment Options

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

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
115 Williamston Ridge Drive
Youngsville, NC 27596
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.