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2020 – November 6th & 7th
Miami, FL
2021 – February 5th
Sydney, Australia
2021 – March 5th & 6th
West Hollywood/ Beverly Hills
2021 – May 7th & 8th
Napa, CA
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Step 1 of 3
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Basic Information
Name
*
First
Last
Email
*
Cell Phone
*
Chiropractic School Attended
*
Year Graduated
*
Please enter a value between 1940 and 2020.
Who invited you to join the UAC?
*
Practice Information
Name of Practice
*
Years in practice?
*
Do you have more than one practice?
*
Yes
No
How many practices do you have?
*
Please enter a value between 1 and 5000.
Do you own businesses in addition to your chiropractic practice?
*
Yes
No
What is the central focus of your practice?
*
What type of business do you have to support the chiropractic profession?
*
Own a practice
Own a business that serves the profession
Both
Please list current annual revenue from each of these businesses
*
$500,000 - $750,000
$750,000 - 1 M
1 M - 5 M
Please list current annual revenue from each of these businesses
*
Please enter a value between 1000 and 200000000.
What are your current average visits per week?
*
Please enter a value between 10 and 5000.
How many employees/contractors do you have?
*
Please enter a value between 1 and 500.
Digging Deeper
Who would you call your mentor(s)?
*
What is your Superpower?
*
What is your Kryptonite?
*
What do you hope to share with the group?
*
What do you hope to learn from the group?
*
What do you hope to teach to the group?
*
