PEICA - Prince Edward Island Counselling Association

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Application for PEICA Membership:

Please ONLY complete the following online membership application form if you are NOT a member through CCPA. Applicant is considered a member once they complete the form and e-transfer payment. A welcome email including receipt of payment will be sent once both are completed.

Payment for PEICA Membership:

CCPA members are strongly encouraged to pay for their PEICA membership when renewing their CCPA membership. Please note, first time members to CCPA will have to call CCPA head office and have the PEICA membership added. After the first time, it then becomes a tick box for future membership renewal.

E-transfers are the preferred way of paying for your membership. Payment can be sent electronically to the treasurer at peicatreasurer@gmail.com. Alternatively, you can pay by cash or cheque. Cheques can be written out to PEI Counselling Association. If paying by cash/cheque, please email peicatreasurer@gmail.com for further payment arrangements. Regardless of how you pay, please ensure you have a receipt of payment.

Surname *

First Name *

Mailing Address. Please include city. *

Postal Code *

Contact Telephone Number *

Email Address *

Highest Education Degree Received *

From What University? *

Year of Graduation *

Area of Specialization *

Work Setting *

I confirm that I do not have a criminal record that might affect my work as a counsellor. *

True

False

If false, please email peicatreasurer@gmail.com details of conviction(s) to be taken into account in considering this application for membership.

Required

I confirm that I have not been dismissed from employment or refused membership in a professional association or registration in counselling or a related field, on the grounds of professional misconduct in Canada or any other country. *

True

False

If false, please email peitreasurer@gmail.com details of matters or sanctions to be taken into account in considering my membership application.

As a member of the Prince Edward Island Counselling Association, I do hereby pledge to uphold the CCPA Code of Ethics at all times. *

True

False

Membership Categories *

Full/Associate PEICA membership $30

Student/Retired PEICA membership$20

Required

I have paid my PEICA membership through CCPA *

Yes

Required

Are you a PEI School Counsellor? *

Yes

I verify all information is true and accurate. Type your name: *

Date: *

YYYY

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