Individual Membership

GLOBAL ASSOCIATION FOR PASTORAL

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Apply for CPE

Global Association for Pastoral Psychotherapy and Chaplaincy (GAPPC)

Membership Application Form

Personal Information

Full Name:

Title (Rev., Dr., Chaplain, etc.):

Date

MM slash DD slash YYYY

Gender:

Nationality:

Address

Street Address City: State/Province: Postal Code: Country:

Phone

Professional Information

Current Occupation/Position:

Organization/Institution:

Type of Ministry/Practice

Chaplaincy

Counseling

Pastoral Psychotherapy

Education

Other:

Additional

Years of Experience:

Highest Degree Earned:

Certifications / Licenses:

Professional Affiliations:

Membership Category

Untitled

Individual Member – Open to professionals in pastoral care, psychotherapy, or chaplaincy.

Student Member – For individuals currently enrolled in CPE, pastoral psychotherapy, and supervisory education programs.

Institutional Member – For persons supportive of GAPPC’s mission without professional credentials.

Partner Member – Senior professionals with demonstrated leadership or publications in the field.

Annual Membership Fee:

Preferred Payment Method:

Online (via www.gappc.org)

Check

Bank Transfer

Statement of Purpose

Please write a short paragraph describing why you wish to join GAPPC and how you hope to contribute to its mission.

Ethical Commitment

I affirm my commitment to uphold the GAPPC Code of Ethics, respect diversity, maintain confidentiality, and embody professional integrity in all aspects of ministry and care.

Signature

Date

MM slash DD slash YYYY

For Office Use Only

Date

MM slash DD slash YYYY

Membership ID

Approved By

Remarks

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Contact Info

Email
info@gappc.org

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Fee

20.00USD

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Global Association for Pastoral Psychotherapy and Chaplaincy (GAPPC)

Membership Application Form