Licensed Professional Counselors Association of North Carolina

Membership

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Application Type

New

Renewal

LPC License #

Applicant Information

*First Name

*Last Name

M.I .

*Address 1

Suite/Apt. No

*City

*Zip

*State

County

Home Phone

Home Fax

*Home EMail

Membership Information

Select your membership type*

Are you a National Certified Counselor?

yes no

Please List All State and National Associations of which You are a Member

Please list the name of the individual who recommended you join LPCANC:

Agreement *

I, as a Professional Member LPCANC, agree to adhere to the Code of Ethics and Standards of Practice set forth by the North Carolina Board of Licensed Professional Counselors. I certify that I am a LPC in good standing with NCBLPC and that the information provided is accurate to date.

I, as a Student Member of LPCANC, certify that I am a student in good standing in a counseling related graduate education program at

I herein agree to these requirements,

* No agreement required for Associate Membership.

Would you like a Board member to contact you about serving on a committee? yes no

If yes, please indicate the two committeess on which you would like to serve:

Mailing Preferences

LPCANC provides most of our news, event notices and updates about the organization and related matters via email and/or fax. This expedites information sharing and reduces our costs. Please indicate below which address you would prefer for each:

Send mail to my:

Send email to my:

Send faxes to my:

Website Directories

LPCANC publishes two directories on its website (www.lpcanc.org): a Membership Directory and a Referral Directory. Members can find each other by name in the Membership Directory. Consumers can find practitioners by the practice demographics listed below and by city in the Referral Directory. Please indicate how, if at all, you would like to be listed in either directory by selecting from the options listed:

Membership Directory:

Referral Directory:

Work Information

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Licensed Professional Counselors Association Of North Carolina