Individual Member Form Essential Info First Name * Last Name * Email Address * End Section Contact Info Address 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 End Section Social Accounts Facebook Instagram Google Linkedin Pinterest End Section 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 If you are human, leave this field blank.
