Membership Registration

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User Email *

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Personal Information

Preferred Title *

First Name *

Last Name *

Contact Information

Phone *

Please Provide an Email Address You Would Like Published *

Practice Name/Employer *

Practice/Employment Address

Would you like to have your practice address published? *

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Practice Website

ACPE Membership

Type of ACPE Membership *

Education Background

Bachelor's Degree Information

Bachelor’s Degree Field of Study *

University *

Year Completed *

Have you completed a masters degree? *

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Religious Affiliation

What is your denomination/religious affiliation? *

Master's Degree Information

Master’s Degree Field of Study *

University *

Year Completed *

Have you completed an additional graduate degree? *

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Additional Graduate Degree Information

Degree Level *

Field of Study *

University *

Year Completed *

Would you like to include one last applicable earned degree? *

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Final Degree Information

Degree Level *

Field of Study *

University *

Year Completed *

Membership Selection and Payment

Choose your membership subscription level. This membership will auto-renew each year on this date. You may cancel at any time. (Some membership levels require verification. Thank you for your patience with the verification process.) *

Regular Member – USD $100
Under Supervision Member – USD $50
Retired Member – USD $25
Student Member – USD $0

Total

USD $0.00

Stripe Gateway *

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Licensure Information

Personal Information

Contact Information

ACPE Membership

Education Background

Bachelor's Degree Information

Religious Affiliation

Master's Degree Information

Additional Graduate Degree Information

Final Degree Information

Membership Selection and Payment