Join/Renew Now!

Our chapter runs the scholastic year with dues payable Oct 1st each year.

Membership Application

If you'd rather not register online, you can print a hard copy to mail in here:

chico_chapter_membership_form_13_14_f.pdf
File Size:	166 kb
File Type:	pdf

Download File

Requirements for membership include:

Current CAMFT membership (Associate and Agency Members Exempt
Current MFT License in good standing, or
Registered Intern or Trainee status with BBS, or
Student ID and documentation of major or program

Agency Membership - Provides the following benefits:

Agency listed on the website
Agency licensed employees can be Chico Chapter Members for 1/2 price ($20) - each individual must be a State CAMFT member
Agency pre-licensed employees can be Chico Chapter Members for free if they are State CAMFT members; if they do not belong to State CAMFT they can still enjoy membership rates for meeting etc.

* Indicates required field

Membership Category *

*Associate members are in a profession related to Marriage & Family Therapy, whose practitioners are licensed, certified or registered pursuant to California law, or an MFT who is licensed in another state.

*Affiliate member is a member in the community who is not in a mental health profession licensed, registered, or certified in the state of California.

New/Renewal *

New Renewal

State CAMFT Membership Number *

State CAMFT Membership Renewal Month *

Name *

First

Last

License Type *

Interns: Who is your Supervisor? *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Website *

Email *

Primary communication between Chico CAMFT and members is via email. If you would like to OPT OUT, and receive communication via USPS mail delivery, initial here: *

Name of Agency *

Agency Address *

Line 1

Line 2

City

State

Zip Code

Country

Agency Phone Number *

Agency Website *

Information for Publication on our Website & Referral Directory:
The information requested below is optional, and will be published exactly as you state it here.
DO NOT fill in any information you do not want visible to the public.

Name *

First

Last

Degree *

License Type *

List Specialties/Modalities (Limit 5) *

Office Address *

Line 1

Line 2

City

State

Zip Code

Country

Interns: Who is your Supervisor? *

Email *

Website *

BBS License or Registration Number *

Do you accept insurance? *

Tell us a little about yourself and your practice. *

Upload a Photo of Yourself *

Max file size: 20MB

To find yourself and your colleagues, we will be putting this information under the tabs: "Who We Are" and "Meet a Member"

*PHOTO INFO*
If you would like to register, but cannot upload a photo or need more time to obtain one, please feel free to register today and send a photo separately to us at chicocamft@gmail.com to include next to your bio.

Submit

Please click the "Submit" button above before you move forward with paying via PayPal. Your data will not be saved in the fields you've just completed if you leave this page before hitting submit. PayPal takes you to a new page.

To download and print a hard copy registration form to mail in,
please click below

chico_chapter_membership_form_13_14_f.pdf
File Size:	166 kb
File Type:	pdf

Download File

Be sure to complete the registration form on the membership page of the website. Even though you have paid, you are not yet registered with Chico CAMFT until we have a completed registration form.

Choose Your Memebership

Our chapter runs the scholastic year with dues payable Sept 1st each year.

All of the information contained on this website has been provided to Chico CAMFT by participating therapists. Chico CAMFT has not reviewed, investigated or evaluated the authenticity, accuracy or completeness of the information contained herein. Chico CAMFT makes no representations as to the qualifications or the competence of those listed. The pages may contain links to other internet sites or an email address. Such links are provided for the convenience of the user and Chico CAMFT does not endorse, approve, or make any warranties or representations as to the accuracy of the information contained in any site to which any user may be linked. Persons or entities using any of the links or email addresses contained herein do so at their own risk. Email should be used with caution. Email is not a confidential medium and should be expected to be confidential. Users who share their email addresses with others may receive viruses and other unintentional consequences.

For questions, please email us at: chicocamft@gmail.com

YOUR CART

Our chapter runs the scholastic year with dues payable Oct 1st each year.

Membership Application

Our chapter runs the scholastic year with dues payable Sept 1st each year.