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Florida Group Psychotherapy Society Membership Application
Member Information
*Note - All individuals signing up for membership with FGPS will be automatically added to the mailing list. If you wish to opt out, please contact us through e-mail.
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1.
Please provide your first and last name
(Required.)
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2.
E-mail address (This information is used to send you a PayPal invoice for membership fees)
(Required.)
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3.
Please provide a contact number
(Required.)
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4.
Mailing address
(Required.)
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5.
Please tell us your profession, license, and a brief description of your practice
(Required.)
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6.
Are you a member of AGPA?
(Required.)
Yes
No
7.
We value the diverse experiences and talents of our members. Whether you would like to simply stay connected or play a more active role, there are many ways to participate. The questions below are optional and will help us understand your interests and how we can make your membership meaningful to you.
What aspects of our mission or activities most interest you?
Continuing Education
Leading presentations
Peer connection & support
Building leadership skills
Events & networking
Other (please specify)
8.
Which of your skills or experiences might you enjoy sharing with our community?
Event planning
Public speaking / training
Writing / editing
Marketing / social media
Fundraising / sponsorship outreach
Administrative or organizational support
Mentoring or supervision
Other (please specify)
9.
How involved would you like to be this year?
Just receiving updates and resources
Occasionally attending events or discussions
Volunteering for a project
Serving on a committee
Joining the Board of Directors
10.
Please select one of the following methods of payment ($15 for student membership, $35 for full membership). Contact flgrouptherapy@gmail.com if you experience issues or concerns.
Paypal
Venmo
Zelle: Send to lashfea@gmail.com