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Membership Type *	Clinical- 1 Year ($65.00) Masters Degree or higher in counseling or a related field that covers the basic principals of Mental Health Counseling OR State license as a Licensed Professional Counselor Clinical- 2 Years ($130.00) Clinical- 3 Years ($195.00) Regular- 1 Year ($65.00) Unlicensed, Masters Degree or higher in counseling or a related field Retired- 1 Year ($25.00) Completely retired from mental health profession Student- 1 Year ($20.00) Enrolled at least half-time in a graduate program in counseling or a related discipline.
Payment System *	Credit Card (PayPal) secure credit card payment Check or Money Order Check or Money Order
Your Name * Your First & Last name
Your E-Mail Address * A confirmation email will be sent to you at this address
Choose a Login Name (User ID) * It must be 4 or more characters in length and may only contain small letters, numbers, and the underscore '_'	check for uniqueness
Choose a Password * Must be 4 or more characters
Confirm your password * Enter password again
Address * Your Mailing Address
City *
State *
Zip Code *
Home or Cell Phone # Insert either your home or mobile telephone number.
License Number
Degree's	LPC LMFT MA Ed.D NCC PhD CSAC Other
Practice Name
Office phone number
Fax Number