Membership Level change

You have selected the Clinical Membership membership level.

This applies if you are:

A California Licensed Marriage and Family Therapist;
Who is a member in good standing of CAMFT.

Subscription period:

1 year, beginning on January 1, 2022.
This is not a recurring payment.

The price for membership is $75.00 now.

Membership expires on January 31, 2023.

Account Information Already have an account? Log in here

Username

Password

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Email Address

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Full Name LEAVE THIS BLANK

More Information

Middle Name

Organization

Website 2

State CAMFT Number

Please enter the number only. If entered incorrectly you will be contacted

Short Description (199 characters max)

Description (2950 characters max)

License and Education

License Type

Other License Type

License #

Intern #

Intern Supervisor Name (n/a if not seeing clients)

Intern Supervisor LIcense # (n/a if not seeing clients)

Degree(s)

Other Degree(s)

Office Locations

Location(s)

Other Office Location

Office Phone

Office Address

Office City

Office State

Office Zip

2nd Office Phone

2nd Office Address

2nd Office City

2nd Office State

2nd Office Zip

Fees

Sliding Scale

Yes

No

Fee (range)

Credit Cards Accepted

Yes

No

Areas of Specialization

Specialization

Do not select more than 6 Areas of Emphasis. Any more will be removed.

Other Specialization

Client Types

Clients

Clinical Orientation

Orientation

Other Specialization

Additional Language Spoken

Additional Language

Other Language

Insurance Accepted

Insurance

Other Insurance

Therapy Groups Offered

Groups

Other Group

Group Description

Supervision (for Therapists)

Supervision

Other Supervision

Supervision Description

Demographic Information

Gender Identity: How do you identify?

Gender Identity

Sexual Identity: How do you identify?

Sexual Identity

Ethnic origin: Please specify your ethnicity.

Other

Multiracial

Employment Status: Are you currently...? Please choose one

Other Employment Status

If licensed, please indicate how many years you have been licensed. Please choose one

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Address 1

Address 2

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Phone

Payment Information We Accept Visa, Mastercard, American Express, and Discover

Card Number

Expiration Date /

Security Code (CVC) (what's this?)

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