Theraplay Association Membership - Add a Directory Listing

Theraplay Association Membership - Add a Directory Listing

$50.00
Full Name:

Name of Agency/Practice:

E-mail:

Directory Listing Website:

Directory Listing Phone:

Directory Listing Address
Please use my:


Directory Listing Logo or Portrait:

Completed Theraplay Coursework
(Individual/Staff):












Theraplay Certification (select all that apply):












Please deliver my newsletter by:



Area of Specialty
(Please limit to 15 words):


Online Directory

If you are already a member, you can add a listing to our web directory for an additional $50. We will synch up your membership to expire one year from the day you join the directory. Please complete the form exactly as you wish your contact information to be listed on-line.

*Please note, the information you provide will be posted on our Online Directory. If you don't want your personal contact information displayed use your work information or leave blank. 

Please fill out THIS FORM after your payment is complete!

 

Join/Renew Theraplay Association Membership Theraplay Association Membership - Add a Directory Listing