PEICA - Prince Edward Island Counselling Association
Application for PEICA Membership:
Please ONLY complete the following online membership application form if you are NOT a member through CCPA.
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.
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Surname
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Your answer
First Name
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Your answer
Mailing Address. Please include city.
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Your answer
Postal Code
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Your answer
Contact Telephone Number
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Your answer
Email Address
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Your answer
Highest Education Degree Received
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Your answer
From What University?
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Your answer
Year of Graduation
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Your answer
Area of Specialization
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Your answer
Work Setting
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Your answer
I confirm that I do not have a criminal record that might affect my work as a counsellor.
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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.
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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.
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True
False
Membership Categories
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Full/Associate PEICA membership $30
Student/Retired PEICA membership$20
Required
I have paid my PEICA membership through CCPA
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Yes
No
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Are you a PEI School Counsellor?
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Yes
No
I verify all information is true and accurate. Type your name:
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Your answer
Date:
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