Certified Pedorthist – Membership Application

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I am a Certified Pedorthist with one of the following credentials C.Ped, BOCPD, C.Ped C or C.Ped MC

Membership Fee $490 plus tax per year (pro-rated/non-refundable)
Membership year runs May 1st – April 30th

The following information is required for the completion of the form below.
Please note: You will need to have the documents listed below before you start completing the form below as you will not be able to save a partially completed form and pick up where you left off.
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1. Proof of Professional Liability insurance with you name on it – not just the company name
2. A picture of the outside of the company where you work
3. A color picture of yourself without sunglasses or a hat
4. Pedorthic credential certificate