Registration:       

Registration for the American Board of Psychotherapy

Register now and begin accruing CEU’s for Certification

Thank you for your interest in pursuing the credentialing certificate as an

American Board Certified Psychotherapist.

Fill out this registration page and begin accruing your CEU hours toward becoming an

American Board Certified Psychotherapist. Please note that you must be a member in good standing of the American College of Psychotherapy.

 

Full Name   _________________________________________________

First                                                  Middle                                                      Last

Please type or print name and degree exactly as it should appear on your certificate.

 

HOME ADDRESS   ______________________________________________________________________

Street City State/Province Zip Code Country

 

BUSINESS ADDRESS _____________________________________________________________________

Street City State/Province Zip Code Country

Preferred Mailing Address: ____ home _____ business        Date of Application __________________

Home Phone (       ) _________________________    Business Phone (         ) _____________________

E-Mail Address ____________________________________ Cell Phone (        ) ____________________

Website   __________________________________________________________________________

 

Submit Payment:   $ 85.00            Register Now

We will send you a form with which to keep us notified about the CEU’s you acquire from those

courses presented by Faculty of the American College of Psychotherapy or those Approved Providers of CEU programs.