Apply for TCA Membership

Name *

First Name

Last Name

Business Street Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business Phone

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Cell Phone *

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Fax Number

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Please Select the Age Groups You Work With *

Young Children (5 or younger)

Children (6-12)

Adolescents (13-17)

Young Adults (18-25)

Adults (26-64)

Seniors (65 or older)

Reference 1: Name *

First Name

Last Name

Reference 1: Phone *

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Reference 2: Name *

First Name

Last Name

Reference 2: Phone *

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Reference 3: Name *

First Name

Last Name

Reference 3: Phone *

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Ethics Acknowledgement *

View Guidelines Here.

I acknowledge the TCA Guidelines of Professional and Ethical Best Practices. I am aware that breach of these guidelines may result in membership revocation.

Rights & Responsibilities *

View Rights & Responsibilities Here.

I acknowledge the TCA Rights, Responsibilities, and Benefits of Membership.

Active Engagement *

I will be actively engaged as a therapeutic, referring professional at least 1/3 of the time (roughly 12-15 clients for referral a year).

Please Select Your Membership Plan: *

Please indicate which membership plan you would like to participate in. Once your membership is approved, you will be able to pay the fee on our website.

Professional Member (Formerly Full Member): $400.00/Year

Associate Member: $400.00/Year

Emeritus Member: $100.00/Year