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The International Medical Spa Association
310 - 17th Street, Union City, New Jersey 07087 .:. phone: 201.865.2065 .:. fax: 201.865.3961 .:. email: medspaassn@aol.com

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MEMBERSHIP APPLICATION

– HOW TO JOIN –
For your convenience we offer three easy ways to join.
 - Complete the application and click "Submit Application" to submit it electronically.
 - Complete the application, print and FAX to (201)865-3961
 - Complete the application, print it and mail with the appropriate membership fee, made payable to: 
 THE INTERNATIONAL MEDICAL SPA ASSOCIATION
 310 - 17th STREET • UNION CITY, NJ 07087 
 Phone: 201/865-2065 • Fax: 201/865-3961
 Email: MedSpaAssn@aol.com
 www.medicalspaassociation.org  

Your membership package, including current benefits, will be sent to you within 2-3 weeks.

Dual membership rates with the Day Spa Association available. Please contact the IMSA/DSA office at (201)865-2065 for further details.

 

 
  I am joining as a Medical Spa/Clinic. I understand my membership is transferable to another person within my organization.
I am enclosing information on my business. All benefits as described in the list of membership benefits will apply
Annual fee $350.00                                                           Add'l person $75.00    Add'l location listings $175.00 ea.
 
 

I am joining as a Supplier/Service Provider to the Industry.
I understand my membership is transferable to another person within my organization.
I am enclosing information on my business All benefits as described in the list of membership benefits will apply
Membership fee $475.00                                                Add'l person $75.00    Add'l category listings $175.00 ea.

 
  I am joining as an individual.
I understand that my membership is not transferable and that I will be listed under my home address and contact information. All benefits as described in the list of membership benefits will apply, except there will be no link to a website.
Membership Fee $225.00
 
PLEASE NOTE: Information submitted on this application will be reflected on the IMSA website. Please clearly  indicate any information you do not want to appear on our website, such as private phone numbers or similar.
 
 Full Name:           Title:
 
 Company:       
 
 Address:            
 City/Province:                State:
 Country:                   Zip Code:
 
 Telephone:                    Fax:
 
 Email:                         Website:
 
 I was referred by the following IMSA member: 
 
    I am enclosing my check in the amount of US$
 
    Please charge my credit card in the amount of US$

 Card Type:     Card#:          Exp. (mm/yy):
 Security code (3 digits):
 
I am applying for membership in the International Medical Spa Association, have read the Code of Ethics and agree:
  1. To adhere to and be governed by the International Medical Spa Association Code of Ethics.
  2. To place the safety of my guests, patients and clients ahead of any other consideration.
  3. To support the organization in its efforts to improve the quality of the medical spa industry

Please include a list of organizations with which you are currently affiliated when submitting your application.
  Signature of Applicant:                                                                           Date: 3/10/2010 12:10:34 PM
 
                                 
 

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