AACP Application for General Membership

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AACP is a national network of community psychiatrists and allied mental health professionals and peers committed to promoting health, recovery and resilience in people, families and communities.

Please complete the following form to apply for general membership to the AACP

Name *

Email Address *

In what setting do you currently work/practice? *

Academia/ PACT Team Medical Director

Administration/Management

Assertive Community Treatment Team

Community mental health center

Consultant

FQHC / Integrated Primary Care

Inpatient hospital unit

Jail/Prison

Outpatient clinic

Outpatient Addictions Program

Private Practice

Short term residential crisis center

Residential treatment

Anders:

Verplicht

Mailing Address *

What kinds of resources, skills and/or supports are you interested in receiving through the AACP?

For renewing members, What have you found most useful/valuable about being a member of AACP?

Are you a new or returning member to the AACP? *

Phone *

What is the number of years you have been out of training?

Please complete your application by submitting payment of $150.00

Pay $150 here via PayPal or Credit Card:
https://www.google.com/url?q=https%3A%2F%2Fwww.paypal.com%2Fcgi-bin%2Fwebscr%3Fcmd%3D_s-xclick%26hosted_button_id%3D4ML5FLL8DVFYN&sa=D&sntz=1&usg=AFQjCNHSsQZb1GuKkSkbCi3E8zke-Ikghw

(Note: PayPal account not required to pay via credit card- simply check out as guest)

Or use Venmo name @community-group

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Dit formulier is gemaakt in American Association for Community Psychiatry. Misbruik rapporteren

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