Individual Member Form Essential Info First Name * Last Name * Email Address * Contact Info Address Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal If you would like to leave your private mailing address type it here. It will not be shown in the the directory. Phone Number * Fax Number Website/URL http(s)://example.com or http(s)://www.example.com Social Accounts Facebook Twitter Google + Linkedin Pinterest About You * Best describes yourself or business. Which category/categories best describe(s) you (check as many as apply): * Administrator (Please clarify using comments below)Artist- DramaArtist- Poetry/Creative WritingArtist- Architecture/DesignArtist- Expressive ArtsArtist- StorytellingArtist- Visual ArtsArtist- Other (Please clarify using comments below)Community Member/AdvocateCounseling Professional- Licensed Clinical Social WorkerCounseling Professional- Licensed Marriage and Family TherapistCounseling Professional- PsychologistCounseling Professional- PsychiatristCounseling Professional- Other (Please clarify using comments below)Creative Arts Therapist- ArtCreative Arts Therapist- Dance/MovementCreative Arts Therapist- DramaCreative Arts Therapist- Expressive ArtsCreative Arts Therapist- MusicCreative Arts Therapist- Other (Please clarify using comments below)Educator/Researcher (Please clarify using comments below)Healthcare Professional- Activities Director/CoordinatorHealthcare Professional- Child Life SpecialistHealthcare Professional- NurseHealthcare Professional- Occupational TherapistHealthcare Professional- Physical TherapistHealthcare Professional- PhysicianHealthcare Professional- Recreational TherapistHealthcare Professional- Social WorkerHealthcare Professional- Speech TherapistHealthcare Professional- Other (Please clarify using comments below)Student (Please clarify using comments below)Other Which category/categories best describe(s) you (check as many as apply): To select multiple entries hold control key down & select with mouse right click. Use this space to clarify the category/categories you chose above or any additional information: Arts for Your Profile Photo * Drop a file here or click to upload Choose File Maximum upload size: 2.1MB A profile picture is required, this can be your profile picture or business logo.When uploading a new photo: 1.) Upload new photo 2.) Uncheck the old photo 3.) Then click on Submit button Lookup
