Membership Categories and Dues

 

Fellows.  Fellows shall be certified by and a diplomate in good standing of an examining board in the member's state or country of residence and practice, and shall have demonstrated exemplary knowledge and service to the health care profession.

Members.  Members shall be a licensed MD, DO or DDS/DMD; hold a PhD or Master's degree; be a bachelor's level healthcare professional working under the supervision of a liecnsed MD or DO; or be a non-doctoral officer of a prominent healthcare organization as determined by the Credentials Committee as empowered by the Board of Directors.

Honorary Members.  At its discretion, the Board of Directors may bestow the title of "Honorary Member" to an individual who has excelled in his or her chosen profession and who has contributed to the cause of optimal health, appearance and performance enhancement.

Associate Members.  A student, intern, resident, or fellow in training may be offered a scholarship in lieu of dues payment as decided by the Credentials Committee as empowered by the Board of Directors.

 

Physicians $150

Other Healthcare Professionals $50

 

To apply for membership in the American College of Rejuvenology, fill out the form below (you will be prompted for payment at the end via Visa, MC or American Express). If you desire another form of payment, you may print out this page and mail to:

American College of Rejuvenology

Attn: Membership Department

P.O. Box 4249

Gulf Shores, Alabama  36547

 

 

Name

Birth Date Place of Birth

Address

City State Zip

Country

Home Phone Fax

Email Address

 

Employment

Organization Title

Address

City State Zip

Country

Work Phone Fax

Email Address

 

Licensure

Type State

License Number Expiration

 

Education

Please email resume to lynn@mccolloughinstitute.com and/or curriculum vitae or provide the information requested.

 

Currently Held Degree(s) and Names of Institutions:

 

Students in Training

College or University/Division

Degree Pursued

Date Entered Program

Graduation Date

 

1.  Have you been convicted of fraud or felony?  

 

2.  Has any action, in any jurisdiction, been taken regarding your license to practice in your profession?  This includes actions involving revocation, suspension, limitation, probation, or any other sanctions or conditions imposed upon a license.  

 

3.  Have you been the subject of any disciplinary action by any professional society or institution?  

 

If you answered yes to any of the above questions please forward complete information

regarding such in the comment section below. 

 

I am currently licensed to practice my profession and my license is in good standing.  I verify that the information on this application is true and that I abide by the Code of Ethics of my professional licensing board.

 

The foregoing information is true and complete. (By clicking on submit you are submitting your electronic signature.)

 

 

 

 

Board of Directors: Click here for a list of the founding board of directors of the ACR.
Members: Click here for a complete list of the members of the ACR.
2005 - American College of Rejuvenology™