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Florida Group Psychotherapy Society Membership Application - Full Membership

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.
1.Please provide your first and last name(Required.)
2.E-mail address (This information is used to send you a PayPal invoice for membership fees)(Required.)
3.Please provide a contact number(Required.)
4.Mailing address(Required.)
5.Please tell us your profession, license, and a brief description of your practice(Required.)
6.Would you be interested in presenting on a topic at an FGPS Lunch and Learn?(Required.)
7.Are you a member of AGPA?(Required.)
8.Do you know or were you referred by a member of the FGPS Board?(Required.)
9.If you answered yes to Question 8, please indicate the name of the Board member.(Required.)