Membership application

Home / Membership / Application

Type of Membership

  • Member - $50
  • Student Member - $20

*Founding members who later become Fellows of CACBT-ACTCC will retain their ‘Founding’ status.
+Founding student members will be eligible to retain their ‘Founding’ status if they renew their membership to the Member level in the year immediately following the conclusion of their studies/ training.

 

Online application

Membership  
 
Contact Information  
*Title:  
 
*First name: *Last name:
*Email:  
 
*Create a password: *Re-type password:
(+) Add email
Email 2:
*Address: *City:
*Province / State: *Postal / Zip code:

(ex: H2K 3Z1)
*Country: *Preferred language of correspondence:

(+) Add an other address
Address 2 example:

1234 Street Name, Office A
City, Prov./State
A1C D2F
Country
*Would you like to have your contact details omitted from our membership directory:
*Phone: Phone 2:

(ex: 123-456-7890 (x123) )
(ex: 123-456-7890 (x123) )
Fax: Website:

(ex: 123-456-7890)
(ex: http://yoursite.com)
Degree
*Highest degree: Other degree
Current Position

Which of the following reflect(s) your current position (please check all that apply)?

Professional Background:
Please use the box below to describe your professional background
Example:
  • Psychologist, Type (e.g., Clinical, Counselling, Neuropsychologist, etc.)
  • Psychological Associate, Type (e.g., Clinical, Counselling, School, etc.)
  • Psychiatrist
  • Therapist/ Counselor
  • Post-doctoral Fellow, Name and Location of Program
  • Student,(Name and Location of Program)
  • Research Staff
Volunteer interest:
Please tell us if you’d like to help CACBT-ACTCC as a volunteer.
Volunteer note: