Refer a Colleague and get Rewarded

In order to recruit professional psychotherapists into our membership, we need your assistance.

Please nominate colleagues that you feel would be assets to the organization by completing the form below. Membership packets will be sent to each name you list.

For each nominated colleague that becomes a member of American Psychotherapy Association, you will receive $25 in credit that can be applied towards membership dues or conference fees.

Proceed below to enter your information and nominate up to 3 colleagues.

Additionally, you may download the referral form if you prefer.

  Download the Referral Form

Enter Your Information - * fields are required

*Full Name:
*Member ID:
Phone Number:
*Specialty:
Fax Number:
*E-mail Address:

*required for confirmation

*May we reference your name when contacting the nominee? Yes No


Enter Colleagues' Information - * fields are required

Nominee #1

*Full Name:
*Specialty:
*Address Line 1:
Address Line 2
*City:
*State/Province:

*Postal Code:

Phone Number:
E-mail Address:

Nominee #2

*Full Name:
*Specialty:
*Address Line 1:
Address Line 2
*City:
*State/Province:

*Postal Code:

Phone Number:
E-mail Address:

Nominee #1

*Full Name:
*Specialty:
*Address Line 1:
Address Line 2
*City:
*State/Province:

*Postal Code:

Phone Number:
E-mail Address:


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