Intern / Resident Annual Membership Form

Intern / Resident Annual Membership Form

"..developing the next generation of Mental Health professionals."
Member Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Current Status
Professional Goal:
In Progress or Completed Degree
Submit Verification of Education (e.g. Transcripts, Copy of conferred Degree)

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Available Start Date:

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Date
The National Consortium for Mental Health Counselors reserves the right to decline membership. Membership is offered to students, residents, professionals, and agencies in the mental health field. The decision to make this a closed group organization benefits the members of the mental health profession. Questions and concerns about seeking membership outside of the normal parameters can be addressed by emailing Info@ncmhc.org.
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Standard$75.00

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Silver$85.00

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Gold$110.00

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Total $0.00
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