American Fascial Distortion Model Association

a Site for FDM Practitioners

Become a Member

If you have any questions about this registration form, click here to send us an email.

  • Account Set-up Info

  • Enter the email address we should use to set up your account and where you would like to receive emails from the AFDMA. This email address will *not* appear in the optional on-line directory unless you also enter in the "Practice Email" field below.

  • Membership Type

    - $1,000 for 6 members / 1 Year
    - $200 / 1 Year
    - $50 / 1 Year
    - Free / 1 Year
    You have selected a Group Membership. After a successful payment you will be able to invite up to %s additional members.
  • Student Members Only: Please enter your expected graduation date (doesn't have to be the exact day) from Medical School.
    Check this box to signify that you are a member in good standing with your national organization. Documentation may be requested.
    Regular Members Only: Select 'Yes" only if you wish your public info to be included in the Online Membership Directory. This setting is ignored for Student Members.

  • Contact Info

  • Required phone number format: (###) ###-####
    Best number to reach you at should we need to contact you for any reason. This number will *not* be published in the optional Online Membership Directory If you would like this number to be listed there, you will also need to enter it into the "Practice Phone" field below..

  • Tell Us About Yourself

    All info from this point on will be considered public info and will be published in the online "Find a Practitioner" directory unless you opted-out above. With the exception of Credentials, all fields are optional, so fill-in only those fields that you want included in your listing.
  • Upload We suggest uploading a "headshot" picture of yourself. You will have an opportunity to upload up to 6 images about your practice below. If you do not upload a profile picture, the AFDMA logo will be used as a placeholder.

  • Tell Us About Your Practice

  • Required phone number format: (###) ###-####
  • Required phone number format: (###) ###-####
  • Published Email for your practice. If same as above, enter again.
  • Drop-down lists US states in alphabetical order followed by Canadian provinces and territories in alphabetical order.
  • To place your map pin, enter the address where you would like the pin placed, then zoom in to your location and and verify it is correct.
  • ×The maximum number of images has been reached.
    • ×+
    • Upload Upload an image to display on your profile. You may upload up to 6 images. For additional images, click the + sign at the lower right of this box. Allowed file types are: .gif, .jpg, .png
    • ×+
    • Upload Upload an image to display on your profile. You may upload up to 6 images. For additional images, click the + sign at the lower right of this box. Allowed file types are: .gif, .jpg, .png

  • Tell Us More About Yourself

  • If not a DO or MD, please provide school where you achieved your healthcare degree and year completed.