Clone of Membership Form

LGPS Member Directory Submission

Share professional details you consent to publish in the upcoming public directory.

Directory listings do not constitute an endorsement by LGPS. Inclusion is limited to individuals with active LGPS membership. Membership must be renewed annually, with each membership year beginning January 1.
Membership Eligibility
- Name
  
  First NameLast Name
- Professional Credentials:
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Professional E-mail:
- Professional Phone Number:
  Format: (000) 000-0000.
- Areas of Clinical Specialty
  List up to three (3) primary areas of clinical specialty.
- Practice or Organization Name
- Populations Served
  
  Other
- Professional Website URL
- Professional Headshot
  
  Browse Files
  Upload a professional headshot or practice logo to accompany your directory listing. If neither is provided, your listing will appear without an image. Cancelof
- Do you currently facilitate or offer any active therapy groups?
- Would you like to list any active therapy groups in the LGPS Member Directory?
- if interested in listing a group, please provide the following information:
- Group Name or Focus
- Brief Group Description
- Intended Population
- Group Location or Virtual Availability
- Is the group currently accepting participants?
- Contact or Referral Information
- Link to Additional Group Information
- Promotional Materials
  
  Browse Files
  
  Cancelof
- Are you currently a Certified Group Psychotherapist (CGP)?
- Would you be interested in learning more about becoming a Certified Group Psychotherapist (CGP) or participating in future LGPS events related to the certification process?
- Signature
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