Membership and Endorsement Renewals due December 31, 2022

All NJ-AIMH membership and Endorsement renewals are due December 31, 2022.

• Payment can be made via PayPal.  Please note you do not need a PayPal account to complete this transaction, you can pay as a “guest” via PayPal.
• Alternately, you can mail a check to NJ-AIMH Renewals, PO Box 43662, Upper Montclair, NJ  07043.

Once we receive your payment, you will receive a confirmation email with your membership confirmation.

If you are also renewing your Endorsement, please click below for instructions for renewing via the Endorsement Application System (EASy).

• INSTRUCTIONS for Renewing NJ-AIMH Endorsement for 2023 via EASy

NJ-AIMH memberships and Endorsements are renewed annually on a calendar year. Registrations received in November and December 2022 will be in effect until December 31, 2023.

I would like to *

Join or Renew annual membership for 2023 ($35)

Join or Renew full time student membership for 2023 ($15)

I have Lifetime Honorary Membership (No fee)

My Info

First Name *

Last Name *

Personal Email Address *

Home Address *

City *

State *

Zip *

My Personal Phone Number *

Name of Agency/Employer *

Job Title *

My Work email *

My Work Phone Number *

Discipline, e.g., early childhood education, social work, psychology, nursing, pediatrics, counseling, OT, speech therapy, etc. *

I use the following pronouns: *

he/him/his

he/they/their

she/her/hers

she/they/their

they/them/their

OtherOther

I prefer not to answer.

I identify racially/ethnically as: *

Asian

Bi-racial

Black

Indigenous

Latinx

Multi-racial

White

OtherOther

I prefer not to answer.

We really want to know who our members are. Is there something you want us to know about how you identify?

I am interested in joining the following committee(s) for 2023: *

College/University Student Engagement

Membership & Endorsement

Public Awareness & Development

Training & Reflective Supervision

I prefer not to choose at this time.

If you are human, leave this field blank.

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