PACCP 2025-2026 Membership and Insurance Renewal

2025-2026 PACCP Membership and Insurance Renewal Form
RENEWAL DEADLINE is May 30th, 2025

All renewals must be received, with payment, in the office prior to that date.

A late fee of $30 will be charged for anything received after that point.

Payments may be made with etransfer to ingrid@paccp.ca with no additional processing fee.

If you want to pay by credit card, a $5.00 processing fee needs to added.

Please be sure to review the Ethical documents you are agreeing to abide by starting this coming membership year!

Code of Ethics - https://paccp.ca/wp-content/uploads/2023/10/PACCP-Code-of-Ethics-2023.pdf

Ethical Complaints Procedure - https://paccp.ca/wp-content/uploads/2023/10/PACCP-Ethics-Complaint-Procedure-2023.pdf
PACCP Member Number
Membership Category (ie. Associate Professional Counsellor)
PACCP Certification Number (if Certified)
First Name*
Last Name*
Mailing Information (not accessible to the public):
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Phone Number
Email (to be used for all PACCP correspondence from the national office)*
example@example.com
Business Address (for Find a Therapist listing; if you don't want an address listed to public viewing, please just fill in your City and Province).

All member names, membership category, city and province must be listed on our Find a Therapist.

You can also access, add and change the information the public sees by logging in at www.paccp.ca
Business Name
Address*

Street Address

CityProvince

Postal
Business Phone Number
Business Email*
Website Address
Please list any professional associations or provincial regulatory body/colleges in which you hold concurrent membership (e.g. College of Psychologists, College of Social Workers, College of Counsellors or Mental Health Therapists, etc). Please include your membership/registration number. The purpose for collecting this information relates to the processing of any ethical complaints that may be received by PACCP. Please see the PACCP's Ethical Complaint Procedure for further information: https://paccp.ca/wp-content/uploads/2023/10/PACCP-Ethics-Complaint-Procedure-2023.pdf
I am employed or work within a contractual relationship in counselling agency? If so, please provide the name and mailing address below.*

YesNo
If yes to above, please indicate name, address and email of counselling agency
Liability Insurance Proof (if you don't have PACCP Insurance you MUST provide proof of your own insurance)

Cancelof
Declaration of Renewal

Must be completed in order to renew.
I confirm all of the following statements:*

I have read, understand, agree to abide by and adhere to the PACCP Statement of Beliefs, PACCP Principles of Practice, the updated and revised PACCP Code of Ethics (https://paccp.ca/wp-content/uploads/2023/10/PACCP-Code-of-Ethics-2023.pdf), and all other regulations and procedures for PACCP Members.I agree to cooperate fully with the National Ethics Complaints Committee and the Ethics Complaint Procedure in the event a formal complaint is lodged against me.I have no active ethical complaints under investigation by an Association, regulatory College, legal system or entity.I have not been the subject of an ethics investigation that resulted in disciplinary sanctions (including educative, reparative, or other corrective required actions).I have not been denied membership in a professional association or registration in a regulatory college for counselling or a related field.I confirm that I do not have any other history of personal and professional conduct that conflicts with the PACCP Code of Ethics.I confirm I do not have a criminal record
Clarification on Above Statements

If you cannot confirm ALL of the above statements, please attach details to be taken into account when considering this application for renewed membership.
Cancelof
By renewing as a member of PACCP, I agree that PACCP is authorized to collect, utilize and disclose personal information to PACCP partner organizations for the purpose of communicating with me the special arrangements entered into with the PACCP, such as liability insurance plans available to members. In addition, I agree that PACCP may share personal information regarding my professional conduct, including disciplinary action, to the appropriate professional associations, regulatory bodies and/or agencies, both governmental and nongovernmental, and on the PACCP website, as required in order to comply with PACCP's mission of protecting the public.*

AgreeDisagreeOther
We are looking for people to serve in a few specific roles within PACCP leadership. Please prayerfully consider if you would be willing to participate with us in these ways.
Needed Service Areas

National Board of Directors: Advocacy and Government RelationsNational Ethics Complaints CommitteeNational Board of Directors: National ConferenceNational Board of Directors: Member CareMB-East Branch Leadership Steering CommitteeSK Branch Leadership TeamNational Ethics Education CommitteeStandards of Practice Development TeamI do not have any interest in serving within PACCPOther
Signed by Member only (by signing your name to this agreement, you are stating that you have filled out the declaration and other information in honesty and integrity) - you may just type your name as a signature*
Date*

MonthDayYear
Date
How can PACCP be praying for you right now and in this coming year?
Any further comments you'd like to provide PACCP
Fee List
Categories:All

All

Membership Fees

Insurance

Additional Fees
prevnext( X )
Membership Fees

Associate Professional Counsellor (APC)
$235.00CAD



Associate Professional Counsellor (APC) - non-practicing
$117.50CAD



Certified Professional Counsellor (CPC)
$255.00CAD



Certified Professional Counsellor (CPC) - non-practicing
$127.50CAD



Certified Professional Counsellor Supervisor (CPCS)
$260.00CAD



Certified Professional Counsellor Supervisor (CPCS) - non-practicing
$130.00CAD



Allied Professional
$210.00CAD



Student-Insured
$110.00CAD



Student Uninsured
$90.00CAD



Retired
$50.00CAD



Insurance

Professional and Commercial General Liability
$235.00CAD



Student Professional and Commercial General Liability
$117.50CAD



Cessation Insurance (2 Years) - OPTIONA:LIncluded for those who held Professional and Commercial General Liability Insurance and are retiring
$ FreeCAD



Cessation Insurance (5 Year) - OPTIONALFor those who want more than the Free 2 year Cessation if retiring
$370.00CAD



Commercial Property Insurance - OPTIONAL
$325.00CAD



Prof. Services Extension - Animals - OPTIONAL
$100.00CAD



Prof. Services Extension - Horses - OPTIONAL
$325.00CAD



Entity Extension (1-5 people) - OPTIONAL
$557.00CAD



Entity Extension (6-10 people ) - OPTIONAL
$838.00CAD



Entity Extension (11-20 people) - OPTIONAL
$1,114.00CAD



Additional Fees

Late Fee (after May 30th)If paying after May 30th, a late fee MUST be added
$30.00CAD



Credit Card Processing FeeIf you are paying by etransfer, please unselect the defaulted credit card processing fee selection.
$5.00CAD



Subtotal

$0.00CAD

Tax

$0.00CAD

Total

$0.00CAD
If you want to pay by etransfer instead of make a credit card payment, please Print Form as a .pdf and email it to ingrid@paccp.ca with your etransfer.

Only hit Submit if you want to pay by credit card. Make sure to include the Credit Card Processing Fee of $5.00.
How will you be paying for your fees?

Etransfer to ingrid@paccp.ca (Choose Print Form below, save as .pdf and email instead of choosing Submit)Credit Card ($5.00 Processing Fee needs to be added)
Should be Empty:

2025-2026 PACCP Membership and Insurance Renewal Form