Join Shapt.org - Houston, TX - shapt.org - Play Therapy  

 

Membership Form

Please fill in all required fields. After submitting your application you will be prompted to pay online for membership, or if you prefer to pay by check download this form and mail.
I would like to join SHAPT as a *
 Regular Member ($20) 
 Student Member ($15) 
Complete Name / Degree / License / Certification *
Home Address *
City *
State/Zip *
Home Phone / Fax *
Work Phone
Organization Name
Address of Organization
E-mail Address (See Note Below)* *
Location of Practice
Specialties *
I am interested in becoming involved in SHAPT *
 Leadership Position 
 Volunteer for Specific Events 
 Presenter 
 Committee Participation 
 Other 
I would like to link my Private Practice on www.shapt.org *
 Yes 
 No 
If yes, the following information will be listed on the website *
 Please list my email address above 
 Do not use the email listed above 
If no, provide additional email address
Area of Town *
If not listed, specify OTHER area
List up to three specialty area (such as LPC/RPT Supervisor, Grief, Bi-lingual)