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[Register for Next
Event][Sampling of Past Meetings][Member Benefits & Activities]
[Articles on Cognitive-Behavior Therapy][Join NJ-ACT][Member Directory][Renew Membership]
Join NJ-ACT
To Join NJ-ACT, you must be licensed for independent practice in New Jersey; or hold a permit to practice psychology in New Jersey; or be licensed for independent practice in another state and live in New Jersey.
Everyone must mail or email a membership application.
You may pay online or mail in your check.
Click "subscribe" for a
3-Month Ongoing Membership - $8.75
Only available online
You may cancel this membership at any time by emailing us at NJACBT@aol.com .
Please copy, paste and email to NJACBT@aol.com or print out the application below and mail it to
NJ-ACT, P.O. Box 2202, Westfield, NJ 07091.
NJ-ACT Membership Application
I am licensed for independent practice in New Jersey or I hold a permit to practice psychology in New Jersey or I am a NJ resident, licensed in another state.
_____ I have paid online
_____$60 is enclosed for a NJ-ACT membership through April 30, 2016.
_____$20 is enclosed for a NJ-ACT membership through April 30, 2015.
Name and Degree ________________________________________ Office County __________
Permit or Licensed As: __________________________ License/Permit Number ____________
Primary Office Address _________________________________________________
Primary Town ___________________________________ State ____ Zip ________
Primary Phone (____)_________________ Email* __________________@__________
Secondary Office Address _______________________________________________
Secondary Town _________________________________ State ____ Zip ________
Secondary Phone (____)_________________ Secondary Office County ___________
*We must have your e-mail address to send you our PDF directory, summaries of research studies, member discussions, and notices of opening and closing dates for workshop registration.
To be listed in our website member directory sign and mail or email the following statement:
Do you want your private practice(s) to be listed on our website Member Directory? (members licensed for independent practice only, please check one)
____ Yes, a complete listing - street address, town, and telephone number.
____ Yes, a partial listing - town and telephone number, without street address.
____ No website listing, please.
“I affirm that my profession’s licensing board permits me to practice independently and without restriction, and there is no complaint against
me pending with my licensing board. I also agree to inform NJ-ACT immediately if any of these stipulations change.”
____________________________________________ ____________
Signature Date
©2014 NJ-ACT. All rights reserved.