International Family Therapy Association Application

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IFTA Membership Application

Please fill out the application fully. There may be several steps depending on membership type and payment method. All fields marked with a red asterisk (*) are required. Please note: to prevent fraud and other misuse, this application needs to be finished within 30 min, otherwise it resets. Javascript is also required for the application to work properly.

** If you have difficulty filling out the membership form, click on this form, complete it and fax or scan it back to the Secretariat, wjhiebert@aol.com

Membership Dues - select one *

* First Time Membership

Renewal/Reactivate Membership
IFTA uses the country categories established by the United Nations' Human Development Index. Category Definitions
Category I Countries

Category II Countries

Category III Countries
See Note 4
See Note 2
See Note 3
Lifetime Membership (One-Time Fee) - $1000
Voluntary Contribution Only
- Note 2: Entitles Group to three (3) individual memberships. Complete names, addresses including country, phone, fax, and email addresses must be provided. Places to fill out information will be provided on next page of application.
- Note 3: Allows Organization/Association to have two (2) individual memberships, e.g., the president, or executive director who may participate and for 1 officer to receive free Congress registration. Complete names, addresses including country, phone, fax, and email addresses must be provided.
- Note 4: A student is defined as a full-time student in a degree-seeking graduate program.

Vountary Contributions

$ for IFTA Scholarship $ for IFTA General Operations/Income
$ Kaslow Fund for Conference Plenary Speakers $ Patricia Lavin Scholarship Fund
Patron $1000+ Supporting $500+ Contributing $200+ Amount: $

Member

Name
1. Salutation: *
2. First/Given Name: *
3. Last/Family Name: *
Last Earned Degree

Gender * Male Female
Mailing Address
1. Address1: *
2. Address2:
3. City: *
4. State/Province: * US/Canada:
5. Province:
6. Country: *
7. Zip/Postal Code: *
Telephone Contact Information *
1. Home: Country Code: Number:
2. Work: Country Code: Number:
3. Fax: Country Code: Number:
Email * Email Address: Verify Email Address:
IFTA uses your email address as the primary means of communication. If you haven't heard from IFTA, check if IFTA has your correct email address.
If your email address is at a university or other organization with anti-spam filtering, please have your server administrator white list the IFTA email address.
New Members - How Did You Hear About Us? Referrer:

Payment Method *

Check Visa Mastercard Discover Card American Express