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Online Application

The Online Application can only be used if you are paying immediately with a credit or debit card via PayPal.*  
(You do NOT have to have your own PayPal account.)

Before completing the online application, please review the "Member Code of Conduct" by selecting the link in the navigation bar above. 
You will be asked to accept these terms as part of the application process.

After selecting the Membership Level, scroll down and click 'NEXT' in the lower right hand corner to proceed.
All items with a red asterisk (*) are mandatory.  

Short on time?  Complete all items with a red asterisk (*) and login later to update your profile.

Thank you for using our easy Online Membership Application!

*If you need to pay by check or money order, you must download the entire application from the membership page and send a check, code of conduct form and the completed application to: 3400 E. Speedway Blvd #118-350, Tucson, AZ 85716. Please allow 14 business days for processing.

Select membership level

Available levels

* Mandatory fields
* Membership Level
 

Copyright © 2010 Arizona Integrative Wellness Coalition.
3400 E. Speedway Blvd #118-350 | Tucson, AZ 85716 | info@azintegrative.org | www.azintegrative.org