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LIFEforce Membership

Be the Change ~ Be LIFEforce!

Prefix*
First Name*
Middle Initial
Last Name*
Business Name (if applicable)
Address Type*
- Business
- Personal
Address*
City*
State*
Enter Province or Territory

If you selected "other" for state, please indicate your answer here.
Postal Code*
Country*
Business Website (if applicable)

If you have a business website, please enter the address here leaving the http:// in front of your website address. If you do not have a website, please leave the default that is in place.
Business Phone (if applicable)
Cell Phone*
Preferred Email*
Is this a personal or business email address?*
- Personal
- Business
Were you referred by a current LIFEforce Tribe Member?*
- Yes
- No
Please list the name of the LIFEforce Tribe Member that referred you - we would like to recognize them.*
Birthdate*
MM slash DD slash YYYY
Shirt Size*
Alma Mater*
Graduation Year*
Facebook URL
Instagram
Additional Comments
Stay Connected!
- YES! I would like to occasionally receive exciting updates & invitations via email and/or text from LIFEforce & Life University.
- No, not at this time.
LIFEforce Mission Statement

We will not stop until everyone on the planet has access to chiropractic care and a chiropractic education if they so choose.

LIFEforce Promise

I will:
Send students to LIFE Leadership Weekend (LLW)
Conduct 2 Student Recruitment Events (SREs) each year in my community
Attend one LIFEforce Weekend at Life University in the next two years
Send 5 Students in the next five years to Life University

Thank you for your dedication to and support of Life University and vitalistic chiropractic. Together we are pushing the profession forward and changing the world.

Contact us for more information at LIFEforce@LIFE.edu and visit our webpage today at http://www.LIFEforce.LIFE.edu.

LIFEforce Membership

Be the Change ~ Be LIFEforce!

Stay Connected!