South Georgia Association for Play Therapy, Inc.

SGAPT Membership Application

*$15.00 Membership fee*

Make checks payable to: SGAPT

Mail to:

JoAnne Mitchell, LPC/S, RPT/S, NCC

c/o SGAPT, 1601 Abercorn St.

Savannah, GA 31401

Name:

Address:

City: State: Zip:

Home Number: Cellular phone:

E-Mail Address:

Degree/Professional Designation:

Employer:

Work Address:

Work Phone:

Date of Application:

Check One: □ Already member of APT/SGAPT

□ Joining APT/SGAPT now

*MEMBERSHIP IN APT IS A PREREQUISITE TO JOINING SGAPT EITHER AS YOUR PRIMARY BRANCH OR TO ADD GEORGIA SOUTH AS A SECONDARY BRANCH*

Special Skills/Interest:

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