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.
Or pay by PayPal below. Remember to send your renewal information to Pam Hart.
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