NACBTpN membership
Email address *
Date *
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Name *
Your answer
Name and location of primary work site or academic program: *
Your answer
Do you currently hold a license as a mental health professional? *
Required
If licensed provide license number
Your answer
License terminal degree *
Other (e.g., area of interest)
Your answer
Interest/practice of CBTp *
Required
Are you willing to be listed as a member on the NACBTp website?
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