Registration

Register for Annual Membership (2018-2019)

Please fill out this form to register for annual membership. If you have any questions, please contact Dawn Breikss by email. All fields with an asterisk (*) are required. Once you have completed the registration, go ahead and click "Submit," then you will be able to pay via Credit Card using Paypal, if that is the payment method you wish to use. Thank you and we look forward to seeing you at our events!

Membership Categories

Professional:  State-licensed Mental Health Counselors, Marriage & Family Therapists, Clinical Social Workers, Psychologists, Psychiatrists, Psychiatric Nurses or Nurse Practitioners.

Associate:  Licensure Candidates, Certified Counselors/Advisers, state-qualified Chemical Dependency Counselor; or any professional who works in a mental health related business or program.

Student/RetiredAny graduate student pursuing a Master’s or Doctoral degree in any mental health field or any retired mental health professional.

Group:  Any employer, clinic, agency, or institution, either private or public with a minimum of three (3) providers who provide direct mental health services. Members have the same privileges as members from the other categories.

Membership Form

Name *
Name
Required field if you are signing up for Group Membership.
Address *
Address
Phone *
Phone
Do you want to be added to our email listserve? *
This is a service (currently under development) where members can communicate directly with each other about referrals, professional questions, or announcements.
Please select your highest degree in the mental health field.
Please select the license you consider PRIMARY.
Please include the state (example: WA MC123456)
Please write in your correct degree and license type here.
Indicate your method of payment. To pay by credit card, click "Submit" first then use the "Add to Cart" options that apply. To pay by check, send check to mailing address below, or pay at the door.
Membership for 2018-2019