The Upper Cervical
Patient Alumni Program
If you would like
to become a member of our national consumer awareness organization,
please fill out and mail or fax the following application.
Patient Alumni
Member Application
Name:_______________________________________________________
Address:__________________________________________________________
Phone Number:_____________________________________________
Email Address:____________________________________________
________Yes, I would
like to become a patient alumni member of N.A.C.U.C.C. Enclosed is my
annual membership donation of $25.00 to receive the Patient Alumni
Quarterly Newsletter.
Name as shown on
card:______________________________________
Master Card__________
Visa____________ American Express__________
My Credit card number
is:_____________________________________
Expiration Date:____________________
Please make
all checks payable to NACUCC
“People Telling People about Upper Cervical
Care”
NACUCC
5215 Colbert Road
Lakeland, Florida 33813
888-622-8221
Email: info@uppercervical.org
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