In order to recruit professional psychotherapists into our membership, we need your assistance. Please nominate colleagues that you feel would be assets to the organization by completing the form below. Membership packets will be sent to each name you list. You will receive $25 in membership bucks for each individual you nominate that becomes a member of APA.
Personal Information
Your Name Specialty Fax
E-mail
May we reference your name when contacting the nominee? Yes No
Nominations
I nominate the following individual(s) for membership in the American Psychotherapy Association:
Name Specialty Address
City State Zip
Name Specialty Address
City State Zip
Name Specialty Address
City State Zip