ABAMHC Antigua & Barbuda, W.I.
info@abamhc.org

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Home
About Us
Membership
- Membership Status
- Membership Benefits
Contact
Resources
Professional Development
Shop
Donations

Membership Application

Home
Membership Application

Membership Applicationadmin_qlmtxeoe2023-06-20T16:58:11-04:00

Thank you for your interest in becoming a member of the The (Antigua and Barbuda) Association of Mental Health Counsellors Inc. (ABAMHC)

For more information regarding ABAMHC membership, including membership criteria and benefits, types of membership, and rates, please visit the Membership section of our website.

To apply for membership, simply complete the online application form. Please note you will be required to submit documentation verifying your enrollment in an approved higher education program, a letter from your internship/practicum Supervisor (if applicable), and verification of professional certifications/ licenses. Verification of Antiguan & Barbudan citizenship or Residency is also required.

If you have any questions regarding the Membership Application, please contact us at info@abamhc.org.

1START APPLICATION

2PERSONAL INFORMATION

3CONTACT INFORMATION

4EDUCATION INFORMATION

5VERIFYING DOCUMENTATION

Where did you hear about us? *

Instagram
Facebook
Twitter
YouTube
Traditional Media (TV/Radio)
Google
Friend or Colleague
Other (please specify):

Type of membership you are applying for: *

Full Membership ($200.00 XCD Annually)
Student Membership ($100.00 XCD Annually)
Affiliate Membership

Are you a former member of the Association?

Are you a citizen of Antigua & Barbuda either by birth, naturalized citizenship, or legal residency? NB: You will be required to submit verification at the end of this application.

Preferred Pronoun *

He
She
They
Other (please specify):
Prefer not to say

Gender

Male
Female
Other (please specify):
Prefer not to say

First Name *

First

Middle

Last

Date of Birth

Ethnicity

Afro-Caribbean
African-American
Caucasian-Caribbean
Caucasian- American
Asian
Hispanic
Other (please specify):

Primary phone number

Secondary phone number

Email Address *

Home Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Do you currently reside in Antigua & Barbuda?

Are you currently enrolled in a higher education (college/ university) program? *

Educational History (Most Recent) *

Please Include: Enrollment Date(mm/yyyy) / Graduation Date (mm/yyyy) / Name of College Institution / Program of Study / Degree Earned

Educational History 2 (If Applicable)

Please Include: Enrollment Date(mm/yyyy) / Graduation Date (mm/yyyy) / Name of College Institution / Program of Study / Degree Earned

Educational History 3 (If Applicable)

Please Include: Enrollment Date(mm/yyyy) / Graduation Date (mm/yyyy) / Name of College Institution / Program of Study / Degree Earned

What is your expected degree upon graduation? (If Applicable)

Associate’s Degree
Bachelor’s Degree
Master’s Degree
Doctorate Degree

Highest Degree Earned, to date *

High School Diploma
Associate’s Degree
Bachelor’s Degree
Master’s Degree
Doctorate Degree

Do you currently hold a professional certification(s) or license(s)? NB: You will be required to submit verification at the end of this application.

What type of professional certification(s) or license(s) do you currently hold? Please list them all in the space below

Professional certification / License expiration date:

VERIFYING DOCUMENTATION

Your application is almost complete. Please upload the required verifications:

Unofficial college/university transcripts
Letter from internship/practicum Supervisor (if applicable)
Copy of professional certification(s) or license(s)
Antiguan & Barbudan citizenship or Residency
Upload Documents (Click Here)

Click or drag files to this area to upload. You can upload up to 10 files.

By entering my first and last names, in the box below, I hereby acknowledge that all information provided in this application is true and accurate to the best of my knowledge. I understand that my information will be used solely for application purposes and will be reviewed by the Association’s Membership Committee. I understand that my information will not be shared with any third parties. If there is a change to any of the information provided on my application, I will notify the Association’s Membership Committee by sending an email to info@abamhc.org.

Electronic Signature *

Please enter your First and Last Names

About Us

The (Antigua and Barbuda) Association of Mental Health Counsellors Inc. (ABAMHC) is the leading professional organization representing mental health practitioners and setting the standard for mental health counselling, in Antigua & Barbuda, West Indies.

Location

ABAMHC
Antigua & Barbuda,
W.I.

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