The McKenzie Institute - McKenzie Website Registration

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McKenzie Website Registration

STOP! ...DO NOT COMPLETE If you:

might be on our mailing list or
have already attended any of our programs

Only complete this form, if you are a healthcare professional new to MIUSA, continue on. This is NOT the form to change an address – Please call 1-800-635-8380 for assistance if you think you are on our mailing list, or return to the login page and follow the instructions.

By completing this form, you are creating your online profile and you will also automatically be added to our mailing list for periodic email or posted mail notifications to ensure you are up-to-speed on the latest McKenzie news and events.

When you complete the form below, each time you visit the site, simply click the Log In button found at the top of the page so you will have full site access.

Register Now for Website Access (only if new to MIUSA)
Name
Salutation		** Occupation
Company Name		License Number
*Address Type
*Address		*City
*State		*Zip Code
Country (if outside USA)		*Phone
Mobile Phone		Fax
*Email		*Password
Website		*Confirm Password

** Required

The McKenzie Institute
432 N Franklin St, Ste 40
Syracuse, NY 13204-1491

Phone: 315-471-7612
Toll-free: 800-635-8380
Fax: 315-471-7636
info@mckenziemdt.org