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Online Membership Application

Persons interested in joining WGPS and renewing WGPS memberscan do so by completing and submitting this online membership application.

2017-2018 Membership Application
Renewal Application $85
Annual Dues ~ $60 Student or New Professional
July 2017 - June 2018

Name:

Degree:

License No

Other Professional Memberships:

Office Address:

(Cont.) Zip:

Phone:

Email:

Fax:

AGPA Member: Yes No

CGP: Yes

Referred by:

New Member? Yes

How did you hear about WGPS?

Please check off if you would like to volunteer in some capacity for WGPS

WGPS Membership type: (****Please see definitions below!!)

CGP/Clinical Member
Associate Clinical Member
Adjunct Member
Research Member
Academic Members
Honorary Members
Students Member/New Professional
Affiliate (non-AGPA) Member

Applicant Signature:


 

Definitions:

(A) Clinical Member – Current Clinical AGPA member. Clinical Membership is automatically granted to those who have the CGP (Certified Group Psychotherapist). For those clinical professionals who do not hold the CGP, clinical membership requires a Master's Degree, licensure, and the following: 300 hours of group psychotherapy experience and at least 75 hours of qualified group supervision. Clinical professionals include the following: psychiatrists, psychologists, social workers, nurses, mental health counselors, marriage and family therapists, pastoral counselors, creative arts therapists, alcohol and drug abuse counselors, and school psychologists.

(B) Associate Clinical Member – Current Associate Clinical Member of AGPA. This level of membership is for clinical professionals with a Master's Degree in a mental health field, as well as state licensure or designated national membership or certification.

(C) Adjunct Member – Adjunct member of AGPA. Adjunct Members are individuals who have experience as leader or co-leader of therapeutic, educational, or consulting groups.

(D) New Professional and Student Member – New Professional and Student Members of AGPA. Students are those individuals who are matriculated in degree or residency programs, or individuals enrolled in certificate-granting programs in the mental health professions and allied fields. New Professionals are those who graduated from such a program within the prior three years. This membership is held on a yearto-year basis and requires proof of student status annually. Special membership benefits are: A special dues rate Eligibility for Scholarships and Grants as available.

(E) Academic Member – Current Academic Member of AGPA. This level of membership is available to Academians who hold at least a Master's degree in their discipline and who have held a faculty position with an accompanying academic appointment at an accredited university or college for a minimum of three years. Teaching must have included at least six courses in the areas of group therapy, theory, or behavior.

(F) Research Professional – Research Professional AGPA member. For those who hold at least a Master's Degree who have published a minimum of two research papers in group studies.

(G) Honorary Members - Non-members of the Society who have rendered distinguished service to the Society. Honorary Members may participate in the affairs of the Society by such activities as serving on but not chairing Committees, and they may not vote or hold office

(H) Affiliate Members

A) Qualifications: Affiliate Members of the Society are mental health clinicians who:

a. Have an undergraduate degree,
b. Have a strong interest in group process or group therapy,
c. Complete an application form,
d. Pay the prevailing membership fee,
e. Be recommended for membership by at least two members of the WGPS Board of Directors

B) Rights and Privileges: Affiliate Members in good standing may be eligible to participate in the affair of the Society by such activates as voting and serving on but not chairing Committees. The Board of Directors of the Society may include up to two non-elected Affiliate Members at any one time. Affiliate Member may not serve as officers.

Dues and membership renewals are due by July 1st.  Please be sure to include your questionnaire describing any groups you run and your malpractice and licensure information.  In filling out the group questionnaire, you can download it (it's a Word document) and type or write in your information, then print it and send it in as directed.