Membership Application

If you are registering on behalf of an organization or corporation please follow the link above to the Organization registration form. If you are registering as an individual please continue to fill out the current form.


Thank you for making a donation to World Spine Care!

Together, we are bringing effective spine care directly to the world's most disadvantaged. Your support is crucial for two reasons:

1. Your membership is essential in funding WSC's flaghship clinics in Botswana and India, and;

2. Becoming a member sends a clear message that the WSC vision is resonating. Demonstrating broad support for the WSC vision is a key factor in creating a sustainable future for our organization.

As a young organization, your membership comes at a crucial time. On behalf of the World Spine Care community, thank you.

Personal Information

With the login name and password you set for yourself below you can access your WSC profile whenever you want (view donation history, change of address, etc). Please note that login names and passwords must be a minimum of 6 characters.



* Login Name:
* Login Password:
* Retype Password:


Prefix:
* First Name:
Middle/Initial:
* Last Name:
Company Name:
Profession:
* Address:
Suite:
* City:
* State/Province:
State/Province (Outside U.S. and Canada):
* Zip/Postal Code: -
Country:
* Primary Phone:
Secondary Phone:
* Email:

Annual Membership Fees
* Membership: Founding Member ($150.00)
Founding Member - Student ($50.00)
The membership you have selected will automatically renew.

We apologize for the inconvenience, however at this time we are not soliciting or accepting online contributions from persons residing in Illinois, Mississippi, Pennsylvania, or West Virginia.

Receipts:
World Spine Care can currently issue charitable receipts for donations issued in the United States. We are working to expand our global charitable representation. Your support during this critical period is greatly appreciated.


Payment Type:
Our payments are processed through the services of BluePay. PCI compliancey is maintained by World Spine Care and BluePay to ensure the safety and security of your personal payment information. All payments will be made in US funds. Credit cards and Paypal can both be accepted.

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