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PARC Membership Application

Newsletter

Board Members

Conferences

PARC HOME PAGE

Name_________________________________Date________________

Mailing Address_____________________________________________

City________________________________State________Zip________

E-Mail Address:_____________________________________________

Phone (Home)________________ (Office)________________________

Employer_________________________Job Title___________________

Work Address_______________________________________________

___________________________________________________________

I have my (circle): CRC/MAC/LPC/LCAS/CCS/ACS

Other certifications (List)_______________________________________

$30 Professional Membership ($15 if join between July1 - December 31)

Membership goes from January 1 to December 31

Graduate degree in rehabilitation counseling or CRC and a graduate degree in closely related field.

Circle: B.S., M.S., Ph.D., Other (specify)__________________________ University____________________________________________________

$15 Student Membership ($7.50 if join between July 1-December 31)

Current student in a graduate Rehabilitation Counseling program or an undergraduate program in Rehabilitation Services.

Circle: Undergraduate - Graduate - Doctoral Student

University/College_____________________________________________ 

Faculty Signature_____________________________________________

With which of the following divisions do you primarily identify?

___ General Rehabilition Counselors (i.e. not a specialist)

___ Substance Abuse Counselors

___ Clinical/Mental Health Counselors

___ Rehabilitation Counselor Educators

Special Interest Groups

Interested in joining any of the following special interest groups?

___Counseling Theories  ___Group Work  ___Holistic (Alternative Healing/Therapies)

___Marriage & Family Counseling  ___Multicultural Aspects  ___Nontraditional Roles

for Rehabilitation Counselors (EAP/Private Practice)  ___Offender Rehabilitation

___Physical Disorders/Disabilities  ___Sexuality  ___Violence (Spouse/Child Abuse,

Crime)  ___Vocational (DVR/VE/Career counseling/Vocational Expert Testimony/Job

Placement)  ___Women's & Men's Issues  ___Other (Describe)__________________

Print and Mail To:

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Send completed form and check for member dues to:

PARC

Dr. Lloyd Goodwin

East Carolina University

Allied Health-Rehab Dept.

Health Sciences Bldg.

Greenville, NC 27858

PARC Application_Form Download

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