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Mental Health Counseling in the Greater Seattle Region 
 
Seattle Counselors Association Membership Application
 Please note that all applications are subject to review prior to approval.
Payment submitted for memberships that are not approved will be returned.
Applications received without consequent payment will not be reviewed. To
become a SCA member, please fill in the required form fields below and mail a signed check to:

Seattle Counselors Association
PO Box 58530
Seattle WA 98138

Membership dues pay for newsletter, website listing, directory, and general
SCA operating costs. If you have questions, please call 206-283-1888.

You can also print and send in your application here.
Category:
   
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Zip:
   
Do You have a practice? Yes No
Practice Name:
Practice Phone :
Agency Name:
Agency Phone:
   
Fax Number:
Email Address: (must be valid to complete registration)
Phone (Home):
Website: (i.e. http://www.seattlecounselors.org)
   
Would you like to receive the newsletter by email? Yes No
   
Short Description of Practice for directory and website (issues with which you commonly help clients, therapeutic approaches, how you work, etc.) This data shows in search lists. (Can be no longer than 300 characters.)
Long Description of Practice for directory and website (issues with which you commonly help clients, therapeutic approaches, how you work, etc.)
   
Professional License or Registration in the State of Washington: (e.g., LMFT, LICSW, LMHC, PhD, RC)
Numbers:
   
RELEASE: I have read the terms of use agreement and grant permission to release this information to other SCA members in the annual SCA membership directory, and to have this same information listed in the directory on SCA’s website. Yes No
   
Home phone numbers are NOT listed on the website or directory.  
   
Select a username:
Enter a password:
Retype your password:
   
 
 
 

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