Affiliate Application Form

Affiliate Application Form
Please review the information on the Membership explained page and be sure you have all the necessary information ready to complete your application. Please Complete the Two Step Process for completing your application for membership with The Canadian Association for Couple and Family Therapy. Please read Step 2 before submitting your application form.
Your Full Name

PrefixFirst NameMiddle NameLast Name
Preferred Prefix
Legal First Name
Middle Name or Initial
Legal Last Name
Email*
This is the email address all CACFT correspondence will be sent to.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home or Cell Number*

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Are you a mental health practitioner?*

YesNo
If you are a mental health provider why do you believe you belong in this membership category rather than Associate membership or RMFT membership?
What is your occupation?*
What is your Masters Degree?*
Please attach your Masters Degree*

Browse Files

Cancelof
Practice Setting
Has your registration, certification or license to practice in the health care industry ever been suspended, revoked, restricted or denied, or has any other disciplinary action been taken against you by any provincial, federal or state, regulatory body or foreign jurisdiction, or are you presently under investigation by any regulatory body or professional association to the best of your knowledge?*

YesNo
All CACFT members are required to be in compliance with the regulatory laws of the jurisdiction(s) in which they practice. It is each member's responsibility to be aware of, and to ensure that they are practicing within, the laws of the jurisdiction(s) in which they practice.
Would you like to join a CACFT Branch? If yes, please indicate which Branch you would like to join.

BC BranchABMBSK
Please note: when you join a CACFT Branch you will be required to pay Branch annual dues as well as CACFT annual dues.

CACFT Affiliate Member annual dues are $82.50 plus tax.

Please click here to read about CACFT Branches.
Step Two

Make your $125.00 application payment.
The annual CACFT membership fee for an Affiliate Member is $82.50 plus taxes. After your membership application is approved you will have fourteen (14) days to pay your annual membership fee.

After you complete the form above you will be redirected to our payment page.

The application fee is non refundable.
If you prefer, you may mail a cheque payable to: CACFT to:

CACFT
Post Office Box 1064
Tottenham, Ontario, L0G 1W0
Should be Empty:

Affiliate Application Form

Step Two