2017 DAMFT Registration Form
Fields marked by * are required.
1. * Name


2. * Degree(s)


3. * License(s)


4. * Are you a supervisor?   Yes     No  

5. * Areas of Expertise (couples, addictions, children)


6.   Employer/School


7. * Office Address


8. * Office Phone


9.   Mobile Phone
List on DAMFT.com   Yes  No   
Clinical Fellows and Pre-Clinical Fellows only


10. * Email
List on DAMFT.com   Yes  No   
Clinical Fellows and Pre-Clinical Fellows only


11.   Your Website


12.   Mailing Address (if different from above)


13.
To join DAMFT your TAMFT dues must be current.

, my TAMFT dues are current. My membership category is:

Clinical Fellow  $75
Pre-Clinical Fellow  $75
Member  $75
Affiliate  $75
Associate  $75
Student Member  $25
Member (2nd half 2017)  $37.50

, I am paying for all CEU meetings this year ($100.)

 Submit this application and proceed to the payment page.

We do not accept cash or checks.
You may pay in person with a credit card only.