Please fill out the following information and submit your payment via paypal.
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:
Include my home information in the directory?
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.
$160 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).
| 