MHC Membership Application
Please fill out the following information to apply for membership.
Choose the membership option you are interested in:
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$30 Community Ally
$200 Individual Professional
I understand that the $30 Community Ally Membership is reserved only for retired and/or those with a personal connection or passion for mental health and wellness and NOT for non-professional or practicing individuals and
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Please Select
Yes
No
I understand the $200 Individual Professional Membership is reserved for practicing individuals; LPCs, LMFTs, MSWs, etc. that do not have an affiliation within an organization.
*
Please Select
Yes
No
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Mailing Address:
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Preferred Membership Benefits
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Access to Events/Training
Networking Opportunities
Volunteer Opportunities
Other
Newsletter
Yes, subscribe me to this newsletter.
Submit
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