Membership Checkout changeMembership Level You have selected the Pre-licensed membership level. Individuals who are currently enrolled in a graduate mental health program or pre-licensed interns/psychological assistants who have a minimum of a master’s degree in a mental health field. The price for membership is $40.00 now. Membership expires after 1 Year. Do you have a discount code? Click here to enter your discount code. Discount Code Already have an account? Log in here.Account Information Member Username This is a personal user identification for your GPALA website profile and will not be displayed anywhere else Password Confirm Password E-mail Address Confirm E-mail Address Full Name LEAVE THIS BLANK More Information Show in Member Directory Yes First Name * Last Name * License Type PhD PsyD LMFT LCSW MFT Intern SW Intern Student Other - Explain in text field below * License Other only fill out if you chose 'Other' from the License Type above License Number Year of Licensure * Additional Licenses, Accreditations and Certifications please separate each license with a comma Supervisor Name Supervisor License Number Specialties AddictionAlcohol AbuseAnger ManagementAnxietyChild or AdolescentCo-Dependency and Love-AddictionCouples TherapyDepressionDrug AbuseEating DisordersFamily ConflictGamblingGrief & LossLGBTQMood DisordersOlder Adults/Change of LifeParent SupportPersonality DisordersRelationship IssuesSelf-HarmingSex TherapySexual AddictionSubstance abuseSuicidal IdeationTrauma * click the teal box to choose multiple specialties Professional Website Address Supervisor Name / Contact Info Office Address Office City Office Zip Office Phone * Office Email Home Address Home Phone Home Email If possible, I prefer to receive my GPALA newsletter: Electronically On Paper * If you’d like to be more involved in GPALA please tell us how. Billing Address First Name - Last Name Address 1 Address 2 City State Postal Code Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands US Armed Forces Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Phone We Accept Visa, Mastercard, American Express and DiscoverPayment Information Card Type Visa Mastercard American Express Discover Card Number Expiration Date 01 02 03 04 05 06 07 08 09 10 11 12 / 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 CVV (what's this?) Discount Code Processing...