THE ALTERNATIVE HEALTH CONNECTION

Registration Form

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STEP 1

We are so excited you are becoming a member of the NIAHC team. In order to expedite the process please complete the form below. If you would like to view the membership benefits just click here.

Practitioners, Schools and Healthy Marketplace Retailers pay as little as $44-$64 per month for the profile and placement of choice. Students pay just $45.50 per year!

Title:

Eg. Dr., Prof.

First Name: *

Optional if you have selected Healthy Marketplace

Middle Name:

Last Name: *

Optional if you have selected Healthy Marketplace

Credentials:

Address Line:

Check here if you do not want the address line displayed on your profile

Country: *

State (Within US): *

State (Outside US): *

City: *

Zip: *

Office Phone: *

Cell Phone:

Fax:

Email Address: *

Check here if you do not want your email displayed on your profile

I agree to abide by the Terms of Use, Privacy Policy and the terms and conditions in the Member Agreement
and the Master Service Agreement (MSA) of the National Institute of Alternative Health Care.

I agree as a Practitioner to fax (to 831-440-3227) or email (to info@niahc.com) my license or certification. I understand that my profile will go live only after you receive my details.

Remember you can always log onto your account to make updates and changes to content Our Member Services team is here to assist you with your needs as you complete the membership process. They can be reached at l 800-670-1980 x 110.

All fields marked with asterisks (*) are required

Published by National Institute of Alternative Health Care., Copyright NIAHC