MEMBERSHIP APPLICATION
Name: ___________________________________________Degree:__________License
No.:______________
Address_______________________________________City______________________State_______Zip______
Phones: (O)________________
(Fax)_______________
(C)_____________
E-Mail
Address:__________________________________
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AAMFT
Credentials (check all that apply):
____Clinical Member, _____Approved
Supervisor, _____Fellow
Dues:
Member - all 491 licenses -
$35.00
Associate/allied professional - $25.00
Student
- $25.00
Make check
payable to Tallahassee Association for Marriage and Family
Therapy
Mail to:
Stephen C. Waltz, LMFT, TAMFT President-Elect, 1621 Metropolitan
Boulevard, Suite D, Tallahassee, FL 32308
Please check
all the committees you would like to serve on:
_____Program
_____Legislative
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