Membership Form (NonConference)

Please complete the following to apply for membership to CTABA.

First Name:

Last Name:

Organization

E-mail Address:

Phone Number:

Street Address:

City:

State:

Zip Code:

The membership types are described below:

Professional Member: Must qualify in one of the following categories:

Licensed as a Applied Behavior Analyst or Behavior Analyst in any state
Full membership of ABAI or APBA
Certified as a BCBA, BCBA-D, or BCaBA
Licensed as a Professional in a field in which behavior analysis falls within the professional’s "Scope of Practice"

NOTE: New Professional members must attach a copy of your vita and course records or a copy of your BACB certificate.

Associate Member: Must qualify in one of the following categories:

Student Member: This category is for any individual pursuing formaltraining in the discipline of behavior analysis services.
Registered Behavior Technician: This category is for individuals who currently hold the RBT credential through the BACB.
Parent: This category is for parents of children who are consumers of behavior analysis services.
Direct Care with no formal qualifications: This category also includes direct services staff for individuals that spend the majority of their working time implementing behavior programs. These individuals must be actively supervised by a professional member.
Sustaining: Members who are able to provide substantial financial support to CTABA.

I am applying for a new membership.

I am renewing my membership.

Professional

Student Member

Registered Behavior Technician

Parent

Direct Care with no formal qualifications

Sustaining

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