Membership Application

Please fill out and submit the form below; instructions for sending your membership fee will appear on a new page after you submit your form. Please follow this link for payment instructions.

Please contact membership@iedta.net for any questions or problems.

Full name and suffix:*
(e.g. "Astra Peraspera, PsyD")
Name:*
First name = given name (e.g. "Astra"); Last name = surname = family name (e.g. "Peraspera")
First Last
Email:*
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Telephone:
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Fax:
Mailing address:*
Street Address City State / Province / Region ZIP / Postal Code Country
Current work or training:*
Include any academic affiliations.
Professional degree:
(e.g. MA, PhD, MD, etc.)
Professional degree earned:
(year)
Post-degree professional training/specialty training:
In practice since:
(year)
Licensing authority:
(e.g. "Board of Registration in Medicine, Massachusetts, USA")
License or certificate number:
Special interests and expertise:
Briefly describe your interest in EDT:
Include any EDT or STDP training.
Do you want to join the EDT-List email discussion group?
For information about the EDT-List, please see the EDT-List Information page.
- Yes
- No
Please tell us how you found out about the IEDTA:
IEDTA Membership (Two-Year Fee)*
IEDTA membership is open to anyone with a university degree and a government-issued registration / certification / license allowing you to practice in your country.
- Regular Membership ($200)
- Student Membership ($100)
- Recent Core Training Graduate Membership - ($100) - First two years of membership, regular membership renewal fees apply thereafter
- Core Trainee Membership ($0.00) - Free for up to 3 years total, while actively enrolled in an IEDTA-Certified Core Training Program
- Retiree Membership ($0.00)
What is the name of the IEDTA-Certified Training Program that is sponsoring you?
This is required for Core Trainee Memberships.
What is the name of your Core Trainer/s?*
This is required for Core Trainee Memberships.
City of Training
Please enter the City in which your training takes place
State of training
Please enter the State in which your training takes place
Country of training
Please enter the Country in which your training takes place
When did you start your Core Training?*
This is required for Core Trainee Memberships.
DD slash MM slash YYYY
When does your Core Training end?*
This is required for Core Trainee Memberships.
DD slash MM slash YYYY
Payment*
Please choose a payment method. Dues are due with the application.
- By paypal.com
- By Credit card
Total
$0.00
Please let us know you are a human being
Type the letters you see.
Thank you for applying to join the IEDTA!

We look forward to having you as a member and as part of the community of experiential dynamic psychotherapists.

Please contact membership@iedta.net for help with any questions or problems.

Please click "Apply to join the IEDTA."
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Membership Application

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