To become a Member

Please print out the application and mail to the address below.

Membership Application

Name and degree _______________________________________________

Address _______________________________________________________

City _________________________________State ___________ Zip ______

Telephone Number (    )_______________ Fax Number (     ) ____________

E-Mail Address _____________________________________________

Business Name ____________________________ Business Phone Number______

Membership Categories (check one)

_____ Clinical (Licensed) -----------------------------------------------------$40

_____ Prelicensed (Trainee, Intern, Social Worker Associate -------------$25

_____ Associate (Licensed in a related mental health field) ---------------$40

_____ Affillate Practioner in another field (e.g. RN, Attorney) -------------$40

CAMFT Member # _______________________________________________

Must be a member of CAMFT to join the local chapter, unless Affillate member)

Dues are paid annually in April.

MAKE CHECKS PAYABLE TO IEC-CAMFT and mail to IEC-CAMFT. Mail registration and check to to IEC-CAMFT, 9708 SVL Box, Victorville, CA. 92392