American Association of

Christian Therapists

P.O. Box 742 + Granbury, Texas 76048

Phone: 817-736-3041 + Fax: See AACT Home Page

Web Page: http://aact.biz

Email: aactonline@Yahoo.com

Membership and Certification

Renewal Check List

Fill out and mail to the AACT so that form arrives at least three weeks before your expiration date

(date on the bottom of your certificate and wallet card)

Name ________________________________________

Member # _____________

Address ____________________________________

State ________ Zip ________

Current Phone No. ___________________

Member/Cert./Lic. Level ______________________

Member since ________________

*Email Address _______________________________

Give us your email address and be added to the NEW AACT group email.

Find out what’s happening on a daily basis

Supervision completed [ ] yes [ ] No + Supervision is not required but encouraged to maintain a more professional practice + Please attach supervision documentation. Under the reorganization of September 2000 all levels except the licensed levels suggest FOUR (4) hours per month.

For LPCC, LPCC Diplomate, LCCC, LCCC Diplomate, LPPC, LPPC Diplomate, LPCC, LPCC Diplomate, LCPT, LCPT Diplomate, LCCT, LCCT Diplomate, LPPT, LPPT Diplomate, LPCT, and LPCT Diplomate – Did you have peer interaction in your counseling ministry [ ] Yes [ ] No + Interaction is suggested for a more professional practice.

Is your counseling practice covered by insurance [ ] Yes [ ] No + Please attach copy of policy.

ANNUAL CERTIFICATION AND MEMBERSHIP FEES ARE AS FOLLOWS

LEVELS AND FEES FLOW CHART FOR ALL RENEWALS

[ ] I am renewing my “Certified Academic Institution”

___ CAI Basic … Your institution offers Christian Therapy or Counseling Courses.

_ CAI Primary … Your institution offers a Bachelors in Counseling or Therapy.

_ CAI Secondary … Your institution offers a Masters in Counseling or Therapy.

___ CAI Premier … Your institution offers a Doctor’s or Ph.D. in Counseling or Therapy

ALL CAI Levels: $99.00

[ ] I am renewing my Church or Ministry Charter (No Charge)

_____ Church _____ Ministry _____ AACT Charter

[ ] I am renewing my Certification or License (Check appropriate line below)

If you have been certified / licensed before June 1, 2007

(Grandfather clause), you may renew with only a

15% increase over your original fee for the next two year's renewals.

AACT is offering two year renewals at double the old price... for this year 2007

Please call the AACT if you have questions.

_____ PASTORAL or CHRISTIAN MEMBER - (Membership Only)

_____ REGISTERED (PASTORAL) (CHRISTIAN) (BIBLICAL) COUNSELOR (Circle one)

(We register you in our data base - non certified level)

Membership and non degreed Registration Level - $89.00

_____ CERTIFIED (PASTORAL) (CHRISTIAN) (BIBLICAL) COUNSELOR (Circle one)

(Requires AACT approved special training or Bachelor’s Degree)

Special Trained non-degree and Bachelor’s Level Certification - $119.00

TRACK 1: PASTORAL & CHRISTIAN COUNSELING

_____ CERTIFIED PROFESSIONAL (PASTORAL) (CHRISTIAN) (BIBLICAL) COUNSELOR (Circle one)

_____ LICENSED PROFESSIONAL (PASTORAL) (CHRISTIAN) (BIBLICAL) COUNSELOR (Circle one)

TRACK 2: PASTORAL & CHRISTIAN THERAPY

_____ CERTIFIED PROFESSIONAL (PASTORAL) (CHRISTIAN) (BIBLICAL) THERAPIST (Circle one)

_____ LICENSED PROFESSIONAL (PASTORAL) (CHRISTIAN) (BIBLICAL) THERAPIST (Circle one)

_____ LICENSED CLINICAL (PASTORAL) (CHRISTIAN) THERAPIST (Circle one)

Master’s Level Certification - $139.00

Master’s & Doctoral License - $159.00

(Diplomate on all Master’s & Doctoral Levels – Please add $25.00)

_____ MARRIAGE AND FAMILY PASTORAL COUNSELOR (Bachelor’s & Master’s level)

_____ MARRIAGE AND FAMILY PASTORAL THERAPIST (Master’s & Doctoral level)

ALL Marriage & Family Levels: $149.00

AMOUNT ENCLOSED __________________

HAVE YOU ENCLOSED ALL

NECESSARY DOCUMENTATION? ____________

Signature ____________________________________

Date ______________