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Join Nefesh - Application Form
Yes, I want to be a member of Nefesh, the International Network of Orthodox Mental Health Professionals!

General Information
Title
First Name*
Last Name*
Home Address*
Country*
City*
State*
Postal Code*
Phone
Cell
E-mail*
Password*
* required Fields

Dues and Payment
Membership Type*
$115.00 - Full Membership - One Person
Available to those who hold professional degrees which render them eligible for licensing in the field of mental health
$160.00 - Full Membership - Husband/Wife
Husband/wife membership is available to couples where each one is eligible for either full or Associate membership
$115.00 - Associate Membership
Available to non-degree holding mental health workers e.g., askanim, counselor, guidance
$100.00 - Affiliate Membership
Available to professionals in disciplines other than mental health, e.g., Rabbis, educators, nursing, law and allied professionals
$35.00 - Student Membership
Available to full-time students
$85.00 - Retired Membership
Available to retired mental health professionals
$95.00 - Full Membership - One Person
Available to those who hold professional degrees which render them eligible for licensing in the field of mental health
$130.00 - Full Membership - Husband/Wife
Husband/wife membership is available to couples where each one is eligible for either full or Associate membership
$95.00 - Associate Membership
Available to non-degree holding mental health workers e.g., askanim, counselor, guidance
$70.00 - Affiliate Membership
Available to professionals in disciplines other than mental health, e.g., Rabbis, educators, nursing, law and allied professionals
$35.00 - Student Membership
Available to full-time students
$85.00 - Retired Membership
Available to retired mental health professionals
$70.00 - Full Membership - One Person
Available to those who hold professional degrees which render them eligible for licensing in the field of mental health
$70.00 - Full Membership - Husband/Wife
Husband/wife membership is available to couples where each one is eligible for either full or Associate membership
$70.00 - Associate Membership
Available to non-degree holding mental health workers e.g., askanim, counselor, guidance
$70.00 - Affiliate Membership
Available to professionals in disciplines other than mental health, e.g., Rabbis, educators, nursing, law and allied professionals
$35.00 - Student Membership
Available to full-time students
$70.00 - Retired Membership
Available to retired mental health professionals
* required Fields

Work / Organization Information
Work Organization or Company Name
Position
Work Address
Country
City
State
Postal Code
Phone
Fax
E-mail

Private Office Information
Private Office Address
Country
City
State
Postal Code
Phone
Fax
E-mail

Profession Information
Please Select
Psychiatrist Counselor Psychiatric Nurse Marriage & Family Therapist Psychologist Social Worker
Other:
Accepted Insurance
Areas of Expertise / Interest
Theoretical Orientation
Degree(s)
Degree Year
Institutions(s)
Languages
English Hebrew Yiddish Spanish French Russian        Other:
Other Information
Preferred Mailing Destination Home Work Private Practice
Please do not print my home information in the annual Nefesh Directory.
Please do not put my information on Find A Therapist.