eNewsletter

LGBT Therapists
MN's lesbian gay
bisexual transgender & allied
mental health providers' network
   

Apply Here

applying for membership

Your membership with LGBT Therapists will help advance the organization's mission of providing professional and social support to its members and the larger community of mental health providers in Minnesota. The organization meets two or three times a year to exchange referral and resource ideas, provide continuing education hours, and advocate the cause of LGBT mental health. Every member is encouraged to participate by attending program meetings, spreading information about the network to the larger community, and helping develop programs. Your membership will also get you listed in the network's online directory and
the opportunity to be linked to your own website. We send out eNewsletters about every other week, in which we can include brief mentions of anything you are looking for or want to promote.


Membership Application Form


Please note:

1)   Include only information on this application for which you are willing to have available in the online Membership Directory, as it will be included on our website.
     
2)   Do not abbreviate.
     
3)   If you have already applied and just want payment information, you can find it here.

Last Name  
First Name  
Middle Initial  
Work Address   
Street Line 1  
Street Line 2  
City  
State  
Zip  
Phone  
Phone type   
Email  
(required for internal network communiations)
Website URL  
Highest Degree   Completed  
License(s)  
do not include my email in the online directory
do not include my address in the online directory
do not include my listing in the online directory
 
Professional Category
Psychologist
Psychotherapist
Social Worker / Clinical
Body / Massage Therapist
Crisis Counselor
Educator / Trainer
Counselor
Advocate / Non-licensed mental health worker
Pastoral Counselor
Chemical Dependency Counselor
Case Manager
Student

Other (please specify)

 
Practice Setting
Private Practice
Agency
For Profit
Non Profit
University
Healthcare
Elementary / Secondary School
Other (please specify)
 
Treatment Type
Individual
Couples
Group
Family
Other (please specify)
   
 
Populations
Adult Gay
Adult Lesbian
Adult Bisexual
Adult Transgender
Adult Heterosexual
Children Gay
Children Lesbian
Children Bisexual
Children Transgender
Children Heterosexual
Adolescents Gay
Adolescents Lesbian
Adolescents Bisexual
Adolescents Transgender
Adolescents Heterosexual
Elders Gay
Elders Lesbian
Elders Bisexual
Elders Transgender
Elders Heterosexual
Female
Male
Both Male and Female
 
Identity

Member identifies as:

Gender identity ~

* ”organization” signifies that member is two or more individuals, and that the organization itself is an LGBT ally and possibly represents various genders and sexualities.
do not include my gender identity in the online directory
do not include my sexual identity in the online directory
 
Other Services
Clinical Supervision
Administrative Supervision
Psychotherapy
Psychological Assessment
Case Management
Advocacy / Referral
Court Representation
Employee Assistance
Spiritual Direction
Other (please specify)
 

Groups (if any)

Comments (if any ~ please limit to 50 words max)

Membership Fees
Membership Year is from January 1st - December 31st

"How to pay" information provided after form submission. Please indicate your level of membership below:

Regular Member $40 (1 year)
Regular Member $75 (2 year)
Student & Retired $20
Additional Contribution amount (please note, this is not tax deductible)
   

Agreement & Form Submission

To become a member of LGBT Therapists, we ask that you read and agree to the following statement.

I do agree with the following mission statement of LGBT Therapists:

LGBT Therapists is a network of lesbian, gay, bisexual, and transgender-identified affirming mental health and social service workers and their friends. The goals of the organization are: (1) to provide an opportunity for professional and social support; (2) to exchange resources and referral ideas; (3) to provide continuing education; and (4) to affirm the lesbian, gay, bisexual and transgender community.

I do further state that the information that I provided in this membership application is accurate to the best of my knowledge. I will notify the network if any of this information changes during the time in which I am a member.

your initials

date

By pressing the submit button, you are digitally signing and submitting your application form.


   
MN LGBT Therapists logo

 

   
LGBT Therapists  • c/o Dennis Christian, LICSW, DCSW
19 South 1st Street, 2208B • Minneapolis, MN 55401
 email
 
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