ACLP Child Life Program Membership Application

Child Life Program Membership Application
Please ensure that you have reviewed the Child Life Program Membership cost that matches the slots needed for your team. For questions and/or support, please email membership@childlife.org.

Click here to review the tiers and costs associated with ACLP Child Life Program memberships.

Submitter's Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
ACLP Number
Child Life Program Leader (if different from submitter)

The child life program leader
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
ACLP Number
Staff List

Complete this section to add your team to your membership. An invoice will be sent once your application is processed.
Please add your staff list below. You MUST include first name, last name, email address, job title, and individual member type for each staff. If known, please include the ACLP ID numbers as this will expedite the processing of your membership.

Only the following membership types are allowed under a child life program: healthcare ally, professional, or associate. Please assign accordingly.
How many staff members are you adding?
Please verify that you are human*
Should be Empty:

Child Life Program Membership Application