Annual Membership Registration
Please complete the information below in order to renew your annual membership or register as a new member with ACEPT by the end of October.
Name of Site/Organization:
(Please make sure to include Name of Organization in 'Memo' for Payment)
Director of Training:
Street Address Line 2
State / Province
Postal / Zip Code
(Each organization is allowed one vote per membership - please indicate your chosen voting member here.)
Voting Representative Email:
ACEPT Guidelines Agreement
As an ACEPT member, my organization and I hereby support the missions of ACEPT and abide by the ACEPT guidelines.
If you have any questions about the guidelines and/or mission of ACEPT, please contact the ACEPT President at firstname.lastname@example.org.
(Please indicate how you want to pay & your memership category.)
How would you like to pay for your membership?
To pay via check (ONLY if company policy necessitates this payment type)
Mail check (with organization/member name indicated on memo line) payable to ACEPT to the ACEPT Treasurer: Greg Harms, Psy.D. 4203 N. Sheridan Rd. #3N Chicago, IL 60613. Please direct questions to email@example.com.
Academic (Graduate School) 100+ ($500)
Academic (Graduate School) 99 ($250)
Clinical Training Program ($100)
Individual Member ($50)
Select your membership option.
( X )
Academic (Graduate School) 100+
A training program with 100 or more students applying for practicum each year.
Academic (Graduate School) 99
A training program with less than 100 students applying for practicum each year.
Clinical Training Program
A practicum site.
A person who joins as an individual rather than as part of an academic program or training site. (NOTE: this category will not be able to participate in the Practicum Fair as an agency.)
Debit or Credit Card
Credit Card Number
Please click one of the PayPal options to complete payment and
Should be Empty: