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Membership Application

Complete the form below to become a GCCST member.

Professional

$75

Licensed professionals & clinicians

Student/Intern/Associate

$35

Students, interns & associates

Membership Application

Are you a current GCCST member?

Yes

Membership Tier

Professional ($75)

Student / Intern / Associate ($35)

First Name

Last Name

What is your status for the upcoming academic year?

I am still a student and need to renew my student rate.

I have graduated / am now working as an Associate or Intern under supervision.

Upload Verification of status (Student ID or screen shot of Associate/Intern status)

Choose File

PDF or Images only; 3 File Max

Credentials

* When possible, use the credential acronym (for example LPC-S). If none, enter N/A or Student.

Email Address

Phone

Mailing Address

Street

Street Line 2 (optional)

City

State

Zip Code

Country

I agree to have my name and credentials listed in the GCCST Member Directory

Yes

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