Individual membership application

Please select your application process*
- I am a graduate, student or faculty member of a training institute recognized by CAPT.
- I am not a graduate, student or faculty member of a training institute recognized by CAPT.
Name of Institute*
Graduation*
- I am a graduate
- I am a student
- I am a faculty member
Please upload a copy of your proof of graduation (certificate/diploma/degree)*
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Please upload a letter from your institute confirming your enrolment*
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Please upload a letter from your institute confirming your faculty status*
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Accepted file types: pdf, doc, docx, tiff, jpeg, png, gif.

Regulated Province*
- I do not practice psychotherapy in a province in which the profession is regulated
- I practice in a province in which psychotherapy is regulated
Province*
Name(s) of Regulatory Healthcare College(s) of which I am a member.*
Please enter the name of the College under which you practice psychotherapy
Registration Number
Registration Number note: please enter the registration number for the College under which you practice psychotherapy.
Province*
Please describe how your work with clients is psychodynamic in nature*
Please submit a CV, any certification(s) associated with psychotherapy training and/or university or college degree*
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CAPT Website Listing
- I consent to listing my name on the CAPT site as a member should be I consent to having my name appear on CAPT’s Members List.
- I do not consent to listing my name on the CAPT site as a member.
Consent to receive CAPT communications*
CAPT regularly produces various electronic communications for members such as “CAPT Bulletins”, “CAPT Networker” and “CAPT Community News”. We would like your consent to continue sharing such electronic communications with you.
- I consent to receive electronic communications from CAPT
- I do not consent to receive electronic communications from CAPT
Code of Ethics*
- I have read and agree to adhere to the CAPT Code of Ethics.

Membership*
- Full Member ($160 CAD / year)
- Student Member ($115 CAD / year)
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Credit Card*

American Express
Discover
MasterCard
Visa
Card number Expiration date Security code Cardholder name
Membership Fee
Please note that CAPT membership fees are annual and non-refundable.
$ 0.00 CAD
Comments
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