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Last Name: First Name: M.I.:
Degree(s) and/or licensure:

Work Information:

Name of Agency or Business:
Work Address:
Work Address 2:
City: County: State: Zip Code:
Work Phone: Work Fax:
Work Email:
Include my work information in the directory?

Home Information:

Home Address:
City: County: State: Zip Code:
Home Phone: Home Fax:
Home Email:
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Send TAIMH mail to:

Please indicate the area(s) you are interested in:
Infant Advocacy
Professional Education
Public Awareness/Membership
Endorsement Committee
Receiving Endorsement

Membership Levels:
$10 Student: TAIMH State Organization, includes all benefits of regular state membership. Copy of Student I.D. required.

$45 State: TAIMH state organization, includes newsletter, directory and member discounts.

$165 World and State Combination: World Association for Infant Mental Health (WAIMH), WAIMH quarterly Infant Mental Health Journal, WAIMH newsletter The Signal, all benefits of TAIMH state membership. (WAIMH membership year begins January 1).
$200 Agency:State Membership for up to 10 members.
$500 Agency: State Membership for 10-40 members.
$600 Agency: State Membership for 41-70 members.

Please enter the names and emails addresses of each member:


Texas Association for Infant Mental Health
1199 S. Beltline Road, Suite 100
Coppell, Texas 75019
972-906-2696