WSCA Membership Referral Form
Use this form to identify non-member colleagues you think should join the WSCA. You'll get a $50 credit on your next dues statement for each DC you refer who joins.

Your Information

Referral Information

Enter the name of the chiropractor you're referring.
Enter the email of the chiropractor you're referring.
Enter the phone number of the chiropractor you're referring.
1) By submitting this form, you agree to allow the WSCA to contact the above individual(s) and indicate you referred them to join the WSCA. We will only make one such attempt per contact method provided. 2) WSCA members are eligible for a $50 dues credit for each referral that joins. There is no limit on referrals/credits. To refer additional DCs, submit another form or contact the WSCA at 3) If you are a 1st-year licensee (not yet paying dues), the credit(s) will be used to defer payments once your dues billing begins. (e.g., Two successful referrals will defer your first dues payment by five months.) 4) Although we will only attempt to contact your referral once by email and once by phone, you will still receive the dues credit if the referral joins within twelve months of you submitting this form.