PA Consortium Membership application

PA Consortium Organization Membership

We are rebuilding a better way. Help us to ensure that your information is correct before we include you in the Parental Alienation Professional Expert Directory. Thanks.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Organization you represent as a member of the consortium
Website
www.yoursite.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Are you willing to do Peer to Peer consulting on cases, laws and so forth?
Credential: Please list what professional credentials and level of degree you have
Please check all organizations you are a member of or work with:

Other
If you selected other, please provide organization name below.
Please provide a short introduction of no more than 1000 words about the organization.
Additional Information
Do you have any articles, scientific, therapeutic, diagnostic research or studies, or mailing lists of experts, alienated adult children that you could share with us? If so, please contact us at paconsortium2021@gmail.com
Please let us know if you give your permission to include you in our Organization Directory of members.
Signature
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PA Consortium Organization Membership