DAMFT - Marriage & Family Therapy

Membership Application
DAMFT meets seven times a year, generally on the first Friday of the month.
A three hour ethics seminar is offered in February.

In order to become a member of DAMFT you must be a current paid member of TAMFT
(paid yearly with AAMFT dues).

Listing on the DAMFT website is only available to dues paying members.
Listing includes name, degree(s), license(s), office address, location, office phone, email and website.

Select One: (required)
My dues with TAMFT are current and I would like to join DAMFT.
I would like to register as a non-member for CEUs only.

Membership Application for current members of TAMFT to join DAMFT.
Fields marked by * are required.

1. Name *

2. Degree *

3. License(s) *

4. Place of Employment

5. Office Address *

6.
Select One Geographic Area *

Allen Arlington Carrollton

Denton Downtown Dallas Duncanville/Desoto

Farmers Branch Fort Worth Garland

HEB Irving Lakewood

Lewisville Mesquite McKinney

N. Richland Hills N. Dallas Oaklawn

Plano Richardson Rockwall

S. Dallas Other

7. Office Phone *

8. Office Fax

9. Email *

List Email on DAMFT.com   Yes No

10. Website

11. Home Address

12. Home Phone

13. Home Fax

14.
Type of Membership *

Clinical $40 + PAC donation (any amount)

Associate $40 + PAC donation (any amount)

Affiliate $40 + PAC donation (any amount)

Student $20 + PAC donation (any amount)

15.
If you are unable to receive the DAMFT Newsletter by email, how would you like to receive it?

Fax Newsletter to

Mail Newsletter to

After submitting this application, remember to
MAIL the appropriate dues to:

Maryellen Dabal, Membership Coordinator
420 N. Carroll Avenue, Suite 140
Southlake, TX 76092

Registration as a non-member for CEUs only.
Fields marked by * are required.

1. Name *

2. Degree(s) *

3. License(s) *

4. Place of Employment

5. Office Address *

6. Office Phone *

7. Office Fax

8. Email *

List Email on DAMFT.com   Yes No

9.
Type of Registration *

One Year of CEUs     $50 per year + PAC donation (any amount)

10.
If you are unable to receive the DAMFT Newsletter by email, how would you like to receive it?

Fax Newsletter to

Mail Newsletter to

After submitting this application, remember to
MAIL the appropriate fees to:

Maryellen Dabal, Membership Coordinator
420 N. Carroll Avenue, Suite 140
Southlake, TX 76092