International Association of Marriage and Family Counselors


Membership Application Form


To Join IAMFC, please print and complete this form, checking your membership level below. Then mail or fax your completed application to:

American Counseling Association
5999 Stevenson Avenue
Alexandria, VA 22304-3300 USA

Tel: 800.347.6647 x 222 (M-F, 8:00 a.m. to 7:00 p.m., ET)
FAX: 800.473.2329 or 703.461.9260 (with credit card information)



1. Registration Information


First Name: ___________________________________________________

Last Name: ___________________________________________________

Street Address: _______________________________________________

City, State: ___________________________________________________

Zip & Country: ________________________________________________

Daytime Phone: _______________________________________________

Fax: _________________________________________________________

E-mail: _______________________________________________________

Social Security #: ______________________________________________



2. Membership Type

IAMFC ONLY MEMBERSHIP
($10 processing fee included) 		JOINT IAMFC/ACA MEMBERSHIP
Professional [   ] $70 [   ] $215
Regular [   ] $70 [   ] $215
New Professional [   ] $54 [   ] $133
Student [   ] $54 [   ] $133
Retired [   ] $54 [   ] $133


Membership in ACA means that you will abide by ACA’s Bylaws and other governing documents and are qualified for the membership category selected. By becoming an ACA member, you are agreeing to be subject to the rules, regulations and enforcement of the terms of the ACA Code of Ethics (available to you at www.counseling.org) that can include appropriate sanctions up to suspension or expulsion from ACA and public notice about any such action.

Important Note: One does not need to obtain membership from ACA in order to become a member of the International Association of Marriage and Family Counselors. However, there is a $10 processing fee for joining just IAMFC. This Fee has already been included in the price above.


3. Payment Method


[   ] Check [   ] VISA [   ] MasterCard [   ] American Express [   ] Discover

Credit Card Number (if applicable): ______________________________________________________

Expiration Date: ____________________________________________________________________

Cardholder's Name as it appears on card: _________________________________________________