MEMBERSHIP APPLICATION

What would you like to do?
NEW Membership
RENEW Membership

I plan to pay by Credit Card
Name
Address for U.S. Mail (Required)
City/Zip:
Phone:
Type of Address: Home    Office #1     Office #2
  --------------------------------------------
Additional Address:
City/Zip:
Phone:
Type of Address: Home    Office #1     Office #2
  --------------------------------------------
Additional Address:
City/Zip:
Phone:
Type of Address: Home    Office #1     Office #2
  --------------------------------------------
Email:
Fax:
Website:
State CAMFT membership is required for all chapter members.
Camft Member#
VOLUNTEER INTERESTS Have a few hours a month? Want to get involved? Indicate your area(s) of interest: Bylaws Committee
FT Ethics Committee
Pre-licensed Support Group
Legislative Committee
Membership Committee
Newsletter Committee
Program Committee
Information and Referral Service
Website/Media Committee
CEU Coordinator
Volunteer Coordinator
Other
TYPES OF MEMBERSHIP - You must choose one: LICENSE NUMBER COST
Clinical (Licensed MFT and State CAMFT member) $60
Prelicensed (Registered Intern or MA program and State CAMFT Member) $25
 
Associate (Licensed professional in a related field and State CAMFT Member $50
Newsletter Subscription only (no member benefits) $30

Once you have completed the application form, you will need to BOTH submit this form (via email OR printing and sending in regular mail) AND you will need to choose a payment method (writing a check OR paying through PayPal).

Please submit this form   
or

print and mail to:
Santa Cruz Chapter, CAMFT
P.O. Box 7563
Santa Cruz, CA 95061
Please select a payment method.

To pay by check, make your check payable to Santa Cruz Chapter, CAMFT and mail it to the address above.

To pay by credit card using Paypal, click on the credit card icon below. Once on the PayPal website, complete your payment. Note: Your receipt will say your payment was sent to webmaster@santacruztherapist.org. Click the back button to return to this page if you want. If you have questions about PayPal, please go to PayPal FAQs.



Thank you!