Intern / Resident Annual Membership Form

Intern / Resident Annual Membership Form

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

First Name Last Name
Address *

Street Address

Street Address Line 2

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Postal / Zip Code
Phone Number *

Area Code Phone Number
Email *
example@example.com
Current Status *
Professional Goal:
In Progress or Completed Degree *

Masters of Arts Masters of Science Doctoral Candidatete
Submit Verification of Education (e.g. Transcripts, Copy of conferred Degree) *

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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

Quantity

Gold $ 110.00

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Total $ 0.00
Mother's Maiden Name *
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Make and Model of First Car *
Your Favorite Pets Name *
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